A-3 | Trends and Outcome of Early Coronary Angiography in Patients with Out-of-Hospital Cardiac Arrest Without ST-Elevation Myocardial Infarction

There is a class I indication for immediate angiography and, if indicated, revascularization in patients with out-of-hospital cardiac arrest (OOHCA) presenting with STEMI. The role of early coronary angiography in OOHCA without STEMI remains unclear. Using the NIS database from January 2015 to December 2020, we examined the utilization of early coronary angiography (coronary angiography within 24 hours of index hospitalization) in OOHCA patients, without STEMI, with initial shockable rhythm (ventricular tachycardia or fibrillation), ages 18-85, without prior DNR/DNI, and not a drowned victim. Multivariate logistic regression analysis was used to determine factors associated with early coronary angiography and its impact on all-cause inpatient mortality. The Cochran-Armitage test was used to evaluate the trend in using early coronary angiography from 2015 when the AHA/ACCF cardiac arrest guideline was updated. A total of 18,645 patients met the inclusion criteria - 3070 (16.5%) had early angiography. From 2015 to 2020, the number of OOHCA patients without STEMI who had early angiography increased till 2018 but declined afterward (p-trend <0.001). Females (p=0.009), Black/African American (p=0.015), earning <25th percentile of their neighborhood income level (p=0.001), admitted on the weekend (p=0.049), with Medicare (p=0.001) or Medicaid (p=0.001) were significantly less likely to undergo early coronary angiography. In contrast, those with household income >75th percentile (p<0.001), with private insurance (p<0.001), who attended a hospital in either the West (p=0.01) or Midwest (p=0.031) were significantly more likely to undergo early coronary angiography. Early angiography was significantly associated with a reduction in all-cause inpatient mortality (aOR 0.59, 95% CI: 0.45 - 0.79), p<0.001). Utilization of early coronary angiography in OOHCA without STEMI peaked in 2018 and then declined. There are racial, socioeconomic, and regional disparities in use of early coronary angiography in patients with OOHCA without STEMI.