Author + information
- Chad J. Zack,
- Pranav Chandrashekar,
- Gregory Barsness and
- Jacob Jentzer
Background: Coronary artery disease has been found in the majority of out-of-hospital cardiac arrest (OHCA) survivors leading consensus guidelines to recommend more liberal use of coronary angiography (CAG) after OHCA. Immediate CAG may be associated with improved survival in OHCA patients without an overt cardiac etiology of arrest. National rates of immediate CAG after OHCA have not been well-defined.
Methods: The National Inpatient Sample was used to identify patients with OHCA aged ≥ 18 years from 2004-2013. OHCA was defined by a diagnosis of cardiac arrest or ventricular fibrillation. We excluded those with a do-not-resuscitate status and ICD-9-CM 99.60 & 99.63 (cardiopulmonary resuscitation) to avoid inclusion of in-hospital cardiac arrest. Patients without a diagnosis of myocardial infarction, ventricular dysrhythmia, or heart failure were considered to have a non-cardiac presentation. CAG occurring on hospital day 0 was defined as immediate. Trends rates of CAG, revascularization, and mortality were assessed.
Results: Over the study period 1,190,133 patients with OHCA were identified with 42.2% having a non-cardiac presentation at the time of arrest. Rates of immediate CAG after OHCA increased from 1.3% in 2004 to 2.9% in 2013 (p < 0.001) for those with a non-cardiac presentation and from 11.8% to 20.8% (p<0.001) for those with cardiac presentation. Nearly half of the patients with a non-cardiac presentation (46.9%) underwent coronary revascularization after immediate CAG compared to 78.7% of those with a cardiac presentation (p<0.001).
In patients with a non-cardiac presentation, survival to discharge was significantly higher in those that underwent revascularization (70.3%) compared to those that did not (34.7%) (p< 0.001). Similarly, survival to discharge was significantly higher in revascularized patients with a cardiac presentation that underwent immediate CAG (82.7 vs. 55.8%, p<0.001).
Conclusions: In a contemporary national registry, immediate CAG in patients with OHCA has increased substantially in the last decade. Early coronary angiography and revascularization is associated with improved survival after OHCA including those with a non-cardiac presentation.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1204-318
- 2017 American College of Cardiology Foundation