Ischemic heart disease diagnosed before sudden cardiac arrest is independently associated with improved survival

Eric C Stecker; Carmen Teodorescu; Kyndaron Reinier; Audrey Uy-Evanado; Ronald Mariani; Harpriya Chugh; Karen Gunson; Jonathan Jui; Sumeet S Chugh

doi:10.1161/JAHA.114.001160

Ischemic heart disease diagnosed before sudden cardiac arrest is independently associated with improved survival

J Am Heart Assoc. 2014 Oct 6;3(5):e001160. doi: 10.1161/JAHA.114.001160.

Authors

Eric C Stecker¹, Carmen Teodorescu², Kyndaron Reinier², Audrey Uy-Evanado², Ronald Mariani², Harpriya Chugh², Karen Gunson³, Jonathan Jui⁴, Sumeet S Chugh²

Affiliations

¹ Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (E.C.S.).
² Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.).
³ Department of Pathology, Oregon Health and Science University, Portland, OR (K.G.).
⁴ Department of Emergency Medicine, Oregon Health and Science University, Portland, OR (J.J.).

Abstract

Background: Sudden cardiac arrest (SCA) is a significant public health problem, and rates of survival after resuscitation remain well below 10%. While several resuscitation-related factors are consistently associated with survival from SCA, the impact of specific comorbid conditions has not been assessed.

Methods and results: The Oregon Sudden Unexpected Study is an ongoing, multisource, community-based study in Portland, Oregon. Patients with SCA who underwent attempted resuscitation between 2002 and 2012 were included in this analysis if there were both arrest and prearrest medical records available. Information from the emergency medical services system, medical examiner, public health division, hospitals, and clinics was used to adjudicate SCA, evaluate comorbidities, and identify medical treatments. Univariate and multivariate analyses were performed to investigate the influence of prearrest comorbidities on survival to hospital discharge. Among 1466 included patients, established resuscitation-related predictors (Utstein factors) were associated with survival, consistent with prior reports. When a panel of prearrest comorbidities was evaluated along with Utstein factors, recognized coronary artery disease was significantly associated and predicted higher odds of survival (unadjusted odds ratio 1.5, P<0.001; adjusted odds ratio 1.5, P=0.02). In multivariable logistic models, prearrest coronary artery disease modified the survival effects of bystander cardiopulmonary resuscitation, but did not modify other Utstein factors.

Conclusions: An established diagnosis of coronary artery disease was associated with 50% higher odds of survival from resuscitated SCA after adjustment for all arrest-related predictors. These findings raise novel potential mechanistic insights into survival after SCA, while highlighting the importance of early recognition and treatment of coronary artery disease.

Keywords: atherosclerosis; heart arrest; myocardial infarction; sudden death.

Publication types

Comparative Study
Research Support, N.I.H., Extramural

MeSH terms

Age Factors
Aged
Aged, 80 and over
Analysis of Variance
Cardiopulmonary Resuscitation / methods
Cardiopulmonary Resuscitation / mortality*
Cause of Death*
Cohort Studies
Confidence Intervals
Coronary Artery Disease / diagnosis
Coronary Artery Disease / mortality
Death, Sudden, Cardiac / prevention & control*
Early Diagnosis
Female
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Ischemia / diagnosis*
Myocardial Ischemia / mortality*
Odds Ratio
Prognosis
Retrospective Studies
Risk Assessment
Sex Factors
Survival Analysis

Abstract

Publication types

MeSH terms

Grants and funding