Outcome predictors of patients with out of hospital cardiac arrest and immediate coronary angiography

Catheter Cardiovasc Interv. 2020 Sep 1;96(3):509-516. doi: 10.1002/ccd.28582. Epub 2019 Nov 12.

Abstract

Background: Out of hospital cardiac arrest (OHCA) is common and associated with low survival rates. Guidelines propose a fast work-up after OHCA including coronary angiography (CA) but little is known about the actual outcome of those patients who undergo immediate CA after OHCA with suspected cardiac origin.

Aim: The aim of this retrospective single-center study was to evaluate the short-term outcomes and predictors of in-hospital mortality in patients who underwent immediate CA after OHCA with suspected cardiac origin.

Methods: We included all consecutive patients with OHCA who underwent immediate CA between January 2011 and December 2015. We defined immediate CA after OHCA as angiography within 2 hr after admission.

Results: Two hundred and nineteen consecutive patients with OHCA were included. Fifty six patients (26%) underwent CA without previous return of spontaneous circulation (ROSC) and with ongoing CPR using the LUCAS-device. One hundred and forty nine patients (67%) died in hospital. Of the 56 patients with CA with ongoing CPR, 55 died and only 1 patient survived to hospital discharge. In a multivariate analysis, older age (OR = 2.03, 95%CI 1.35-3.03; p = .001), initial shockable rhythm (OR = 0.28, 95%CI 0.07-1.13; p = .076), CA with ongoing CPR (OR = 11.63, 95%CI 1.20-122.55; p = .035), and initial arterial pH (OR = 0.008, 95%CI 0.00-0.228; p < .005) remained as independent predictors for in-hospital mortality.

Conclusions: In this study older age, metabolic derangement on admission, initial nonshockable rhythm and failure to achieve ROSC before admission predicted in-hospital mortality. While CA with ongoing CPR with the LUCAS-device was feasible, mortality in patients without previous ROSC was extremely high, questioning whether this approach is medically useful.

Keywords: AMI-acute myocardial infarction; CAD-coronary artery disease; CS-cardiogenic shock; OHCA-out of hospital cardiac arrest; ROSC-return of spontaneous circulation.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cardiopulmonary Resuscitation
  • Coronary Angiography*
  • Electric Countershock
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / diagnostic imaging*
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / therapy
  • Patient Admission
  • Predictive Value of Tests
  • Retrospective Studies
  • Return of Spontaneous Circulation
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome