Outcomes and relevance of emergency percutaneous coronary angiography and intervention after resuscitated cardiac arrest: a retrospective study.

Details

Serval ID
serval:BIB_7353DA0EDBFD
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Outcomes and relevance of emergency percutaneous coronary angiography and intervention after resuscitated cardiac arrest: a retrospective study.
Journal
BMC cardiovascular disorders
Author(s)
Bourlond B., Dupré M., Carron P.N., Liaudet L., Eeckhout E.
ISSN
1471-2261 (Electronic)
ISSN-L
1471-2261
Publication state
Published
Issued date
13/08/2024
Peer-reviewed
Oui
Volume
24
Number
1
Pages
425
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
In patients resuscitated from cardiac arrest and displaying no ST-segment elevation on initial electrocardiogram (ECG), recent randomized trials indicated no benefits from early coronary angiography. How the results of such randomized studies apply to a real-world clinical context remains to be established.
We retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses.
We analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients.
Our results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation.
Keywords
Humans, Retrospective Studies, Male, Coronary Angiography, Female, Middle Aged, Aged, Out-of-Hospital Cardiac Arrest/therapy, Out-of-Hospital Cardiac Arrest/mortality, Out-of-Hospital Cardiac Arrest/diagnosis, Out-of-Hospital Cardiac Arrest/diagnostic imaging, Out-of-Hospital Cardiac Arrest/physiopathology, Percutaneous Coronary Intervention/mortality, Percutaneous Coronary Intervention/adverse effects, Time Factors, Treatment Outcome, Cardiopulmonary Resuscitation/adverse effects, Cardiopulmonary Resuscitation/mortality, Risk Factors, Databases, Factual, Predictive Value of Tests, Electrocardiography, ST Elevation Myocardial Infarction/mortality, ST Elevation Myocardial Infarction/therapy, ST Elevation Myocardial Infarction/diagnostic imaging, ST Elevation Myocardial Infarction/diagnosis, ST Elevation Myocardial Infarction/physiopathology, Risk Assessment, Heart Arrest/therapy, Heart Arrest/mortality, Heart Arrest/diagnosis, Heart Arrest/physiopathology, Heart Arrest/etiology, Aged, 80 and over, Cardiac arrest, Coronary angiography, Percutaneous intervention, ST segment elevation, Survival
Pubmed
Open Access
Yes
Create date
19/08/2024 10:21
Last modification date
20/08/2024 7:24
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