Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival

Ludvig Elfwén; Rickard Lagedal; Stefan James; Martin Jonsson; Ulf Jensen; Mattias Ringh; Andreas Claesson; Jonas Oldgren; Johan Herlitz; Sten Rubertsson; Per Nordberg

doi:10.1016/j.ahj.2018.03.009

Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival

Am Heart J. 2018 Jun:200:90-95. doi: 10.1016/j.ahj.2018.03.009. Epub 2018 Mar 13.

Authors

Affiliations

¹ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden.
² Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden.
³ Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Sweden. Electronic address: stefan.james@ucr.uu.se.
⁴ Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden.
⁵ Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Sweden.
⁶ Center for Pre-Hospital Research in Western Sweden and the School of Health Sciences, University of Borås and Sahlgrenska University Hospital.

PMID: 29898854
DOI: 10.1016/j.ahj.2018.03.009

Abstract

Background: The potential benefit of early coronary angiography in out-of-hospital cardiac arrest (OHCA) patients without ST elevation on ECG is unclear. The aim of this study was to evaluate the association between early coronary angiography and survival in these patients.

Methods: Nationwide observational study between 2008 and 2013. Included were patients admitted to hospital after witnessed OHCA, with shockable rhythm, age 18 to 80 years and unconscious. Patients with ST-elevation on ECG were excluded. Patients that underwent early CAG (within 24 hours) were compared with no early CAG (later during the hospital stay or not at all). Outcomes were survival at 30 days, 1 year, and 3 years. Multivariate analysis included pre-hospital factors, comorbidity and ECG-findings.

Results: In total, 799 OHCA patients fulfilled the inclusion criteria, of which 275 (34%) received early CAG versus 524 (66%) with no early CAG. In the early CAG group, the proportion of patients with an occluded coronary artery was 27% and 70% had at least one significant coronary stenosis (defined as narrowing of coronary lumen diameter of ≥50%). The 30-day survival rate was 65% in early CAG group versus 52% with no early CAG (P < .001). The adjusted OR was 1.42 (95% CI 1.00-2.02). The one-year survival rate was 62% in the early CAG group versus 48% in the no early CAG group with the adjusted hazard ratio of 1.35 (95% CI 1.04-1.77).

Conclusion: In this population of bystander-witnessed cases of out-of-hospital cardiac arrest with shockable rhythm and ECG without ST elevation, early coronary angiography may be associated with improved short and long term survival.

Publication types

Multicenter Study
Observational Study

MeSH terms

Aged
Cardiopulmonary Resuscitation* / methods
Cardiopulmonary Resuscitation* / statistics & numerical data
Coronary Angiography* / methods
Coronary Angiography* / statistics & numerical data
Coronary Occlusion* / complications
Coronary Occlusion* / diagnostic imaging
Coronary Occlusion* / mortality
Coronary Occlusion* / therapy
Early Diagnosis
Early Medical Intervention / methods
Electrocardiography / methods*
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest* / diagnosis
Out-of-Hospital Cardiac Arrest* / epidemiology
Out-of-Hospital Cardiac Arrest* / etiology
Out-of-Hospital Cardiac Arrest* / therapy
Outcome and Process Assessment, Health Care
Patient Admission / statistics & numerical data
Registries / statistics & numerical data
Sweden / epidemiology