Early Coronary Angiography and Survival After Out-of-Hospital Cardiac Arrest

Ankur Vyas; Paul S Chan; Peter Cram; Brahmajee K Nallamothu; Bryan McNally; Saket Girotra

doi:10.1161/CIRCINTERVENTIONS.114.002321

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Early Coronary Angiography and Survival After Out-of-Hospital Cardiac Arrest

Journal article

Open access

Peer reviewed

Early Coronary Angiography and Survival After Out-of-Hospital Cardiac Arrest

Ankur Vyas, Paul S Chan, Peter Cram, Brahmajee K Nallamothu, Bryan McNally and Saket Girotra

Circulation. Cardiovascular interventions, Vol.8(10), pp.e002321-e002321

10/2015

DOI: 10.1161/CIRCINTERVENTIONS.114.002321

PMCID: PMC4603281

PMID: 26453686

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Abstract

Although out-of-hospital cardiac arrest is common because of acute myocardial infarction, it is unknown whether early coronary angiography is associated with improved survival in these patients. Using data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 4029 adult patients admitted to 374 hospitals after successful resuscitation from out-of-hospital cardiac arrest because of ventricular fibrillation, pulseless ventricular tachycardia, or unknown shockable rhythm between January 2010 and December 2013. Early coronary angiography (occurring within one calendar day of cardiac arrest) was performed in 1953 (48.5%) patients, of whom 1253 (64.2%) received coronary revascularization. Patients who underwent early coronary angiography were younger (59.9 versus 62.0 years); more likely to be men (78.1% versus 64.3%), have a witnessed arrest (84.6% versus 77.4%), and have ST-segment-elevation myocardial infarction (32.7% versus 7.9%); and less likely to have known cardiovascular disease (22.8% versus 35.0%), diabetes mellitus (11.0% versus 17.0%), and renal disease (1.8% versus 5.8%; P<0.01 for all comparisons). In analysis of 1312 propensity score-matched pairs, early coronary angiography was associated with higher odds of survival to discharge (odds ratio 1.52 [95% confidence interval 1.28-1.80]; P<0.0001) and survival with favorable neurological outcome (odds ratio 1.47 [95% confidence interval 1.25-1.71]; P<0.0001). Further adjustment for coronary revascularization in our models significantly attenuated both odds ratios, suggesting that revascularization was a key mediator of the survival benefit. Among initial survivors of out-of-hospital cardiac arrest caused by VF or pulseless VT, we found early coronary angiography was associated with higher odds of survival to discharge and favorable neurological outcome.

Prospective Studies

Humans

Middle Aged

Male

Out-of-Hospital Cardiac Arrest - mortality

Treatment Outcome

Out-of-Hospital Cardiac Arrest - diagnosis

Coronary Angiography

Out-of-Hospital Cardiac Arrest - therapy

Propensity Score

Survival Analysis

Aged, 80 and over

Female

Registries

Aged

Early Diagnosis

Details

Title: Subtitle: Early Coronary Angiography and Survival After Out-of-Hospital Cardiac Arrest
Creators: Ankur Vyas - From the Division of Cardiology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City (A.V., S.G.); Division of Cardiology, Department of Internal Medicine, Saint Luke's Mid America Heart Institute, Kansas City (P.S.C.); Division of General Internal Medicine, Department of Internal Medicine, Mt Sinai/UHN Hospitals, Toronto, ON Canada (P.C); Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence and the Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (B.K.N); and Department of Emergency Medicine, Emory University School of Medicine, Atlanta (B.M.). ankurvyas7@gmail.com
Paul S Chan - From the Division of Cardiology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City (A.V., S.G.); Division of Cardiology, Department of Internal Medicine, Saint Luke's Mid America Heart Institute, Kansas City (P.S.C.); Division of General Internal Medicine, Department of Internal Medicine, Mt Sinai/UHN Hospitals, Toronto, ON Canada (P.C); Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence and the Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (B.K.N); and Department of Emergency Medicine, Emory University School of Medicine, Atlanta (B.M.)
Peter Cram - From the Division of Cardiology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City (A.V., S.G.); Division of Cardiology, Department of Internal Medicine, Saint Luke's Mid America Heart Institute, Kansas City (P.S.C.); Division of General Internal Medicine, Department of Internal Medicine, Mt Sinai/UHN Hospitals, Toronto, ON Canada (P.C); Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence and the Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (B.K.N); and Department of Emergency Medicine, Emory University School of Medicine, Atlanta (B.M.)
Brahmajee K Nallamothu - From the Division of Cardiology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City (A.V., S.G.); Division of Cardiology, Department of Internal Medicine, Saint Luke's Mid America Heart Institute, Kansas City (P.S.C.); Division of General Internal Medicine, Department of Internal Medicine, Mt Sinai/UHN Hospitals, Toronto, ON Canada (P.C); Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence and the Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (B.K.N); and Department of Emergency Medicine, Emory University School of Medicine, Atlanta (B.M.)
Bryan McNally - From the Division of Cardiology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City (A.V., S.G.); Division of Cardiology, Department of Internal Medicine, Saint Luke's Mid America Heart Institute, Kansas City (P.S.C.); Division of General Internal Medicine, Department of Internal Medicine, Mt Sinai/UHN Hospitals, Toronto, ON Canada (P.C); Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence and the Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (B.K.N); and Department of Emergency Medicine, Emory University School of Medicine, Atlanta (B.M.)
Saket Girotra - From the Division of Cardiology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City (A.V., S.G.); Division of Cardiology, Department of Internal Medicine, Saint Luke's Mid America Heart Institute, Kansas City (P.S.C.); Division of General Internal Medicine, Department of Internal Medicine, Mt Sinai/UHN Hospitals, Toronto, ON Canada (P.C); Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence and the Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (B.K.N); and Department of Emergency Medicine, Emory University School of Medicine, Atlanta (B.M.)
Resource Type: Journal article
Publication Details: Circulation. Cardiovascular interventions, Vol.8(10), pp.e002321-e002321
DOI: 10.1161/CIRCINTERVENTIONS.114.002321
PMID: 26453686
PMCID: PMC4603281
ISSN: 1941-7640
eISSN: 1941-7632
Grant note: K08HL122527 / NHLBI NIH HHS K24 AR062133 / NIAMS NIH HHS R01 HL123980 / NHLBI NIH HHS 1R01HL123980 / NHLBI NIH HHS K08 HL122527 / NHLBI NIH HHS K23 HL102224 / NHLBI NIH HHS
Language: English
Date published: 10/2015
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984094368902771

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