Key result
In hemodynamically stable patients treated with mild therapeutic hypothermia after out-of-hospital cardiac arrest due to ventricular fibrillation, percutaneous coronary intervention was independently associated with reduced in-hospital mortality (OR 0.30).
Why the study?
Does routine coronary angiography with percutaneous coronary intervention improve in-hospital survival in hemodynamically stable patients resuscitated from out-of-hospital cardiac arrest due to ventricular fibrillation?
Observational (n=111)
Yes
Does routine coronary angiography with percutaneous coronary intervention improve in-hospital survival in hemodynamically stable patients resuscitated from out-of-hospital cardiac arrest due to ventricular fibrillation?
Odds Ratio: 0.3 (95% CI 0.11–0.79)
p-value: p=0.01
Routine coronary angiography with PCI is independently associated with improved in-hospital survival in hemodynamically stable patients treated with mild therapeutic hypothermia after out-of-hospital cardiac arrest due to ventricular fibrillation.
May support PCI consideration in stable post-arrest patients; leaves open randomized confirmation of routine angiography benefit.
INTRODUCTION: Since 2003, we have routinely used percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) to treat patients < 80 years of age after out-of-hospital cardiac arrest (OHCA) related to ventricular fibrillation. The aim of our study was to evaluate the prognostic impact of routine PCI in association with MTH and the potential influence of age. METHODS: We studied 111 consecutive patients resuscitated successfully following OHCA related to shock-sensitive rhythm. They were divided into five groups according to age: < 45 years (n = 22, group 1), 45 to 54 years (n = 27, group 2), 55 to 64 years (n = 22, group 3), 65 to 74 years (n = 23, group 4) and ≥75 years (n = 17, group 5). Emergency coronary angiography was performed in hemodynamically stable patients < 80 years old, regardless of the electrocardiogram pattern. MTH was targeted to a core temperature of 32°C to 34°C for 24 hours. RESULTS: Most patients (73%) had coronary heart disease, although its incidence in group 1 was lower than in other groups (41% versus 81%; P = 0.01). In group 1, all patients but one underwent coronary angiography, and 33% of them underwent associated PCI. In group 5, only 53% of patients underwent a coronary angiography and 44% underwent PCI. Overall in-hospital survival was 54%, ranging between 52% and 64% in groups 1 to 4 and 24% in group 5. Time from collapse to return of spontaneous circulation was associated with mortality (odds ratio (OR) = 1.05 (25th to 75th percentile range, 1.03 to 1.08); P < 0.001), whereas PCI was associated with survival (OR = 0.30 (25th to 75th percentile range, 0.11 to 0.79); P = 0.01). CONCLUSIONS: We suggest that routine coronary angiography with potentially associated PCI may favorably alter the prognosis of resuscitated patients with stable hemodynamics who are treated with MTH after OHCA related to ventricular fibrillation. Although age was not an independent cause of death, the clinical relevance of this therapeutic strategy remains to be determined in older people.
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Cronier et al. (2011) conducted an observational in Out-of-hospital cardiac arrest due to ventricular fibrillation (n=111). Percutaneous coronary intervention (PCI) vs. No PCI was evaluated on In-hospital mortality (OR 0.30, 95% CI 0.11-0.79, p=0.01). In hemodynamically stable patients treated with mild therapeutic hypothermia after out-of-hospital cardiac arrest due to ventricular fibrillation, percutaneous coronary intervention was independently associated with reduced in-hospital mortality (OR 0.30).
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