Shockable rhythm as an independent prognostic factor in patients with non-ST elevation undergoing percutaneous coronary intervention after out-of-hospital cardiac arrest: a registry-based cohort study

Q: What are the key findings of this study?

In patients with non-ST-elevation out-of-hospital cardiac arrest undergoing percutaneous coronary intervention, an initial shockable rhythm was independently associated with survival to hospital discharge (aOR 5.38).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Non-ST-elevation out-of-hospital cardiac arrest (n=105). Intervention: Initial shockable rhythm vs. Non-shockable rhythm. Primary outcome: Survival to hospital discharge (aOR 5.38, 95% CI 1.77-18.02, p=0.005).

Q: What does this research mean for the field?

In patients with non-ST-elevation out-of-hospital cardiac arrest who undergo percutaneous coronary intervention, an initial shockable rhythm and prehospital return of spontaneous circulation are independent predictors of survival and favorable neurological outcomes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sujeong Shin; Jae Yun Ahn; Sungbae Moon; Do won Lee; Yun Jeong Kim; Dong Eun Lee; Jung Ho Kim; Sang-Hun Lee; Hyung Jun Hoh; Hyun Wook Ryoo

doi:10.12701/jyms.2026.43.62

September 4, 2026Yeungnam University Journal of MedicineOpen Access

Shockable rhythm as an independent prognostic factor in patients with non-ST elevation undergoing percutaneous coronary intervention after out-of-hospital cardiac arrest: a registry-based cohort study

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Key result

Initial shockable rhythm associates with ~438% greater survival odds in NSTE-OHCA patients undergoing PCI.

aOR 5.38
95% CI 1.77-18.02
P=0.005
n=105

Why the study?

Characteristics associated with favorable outcomes in patients with non-ST-elevation undergoing PCI after out-of-hospital cardiac arrest remain unclear.

Does initial shockable rhythm and prehospital ROSC predict survival and favorable neurological outcomes in patients with non-ST-elevation OHCA undergoing PCI?

Key Points

To identify clinical factors independently associated with survival to hospital discharge and favorable neurological outcomes in patients with non-ST-elevation out-of-hospital cardiac arrest undergoing percutaneous coronary intervention.
Retrospective cohort study analyzing a prospectively collected citywide registry in Daegu, Korea (2018–2022) of adult non-ST-elevation cardiac arrest patients who underwent both coronary angiography and percutaneous coronary intervention (N=105).
Multivariable Firth's penalized logistic regression was conducted to determine independent predictors of survival to hospital discharge and favorable neurological outcomes (cerebral performance category 1–2).
Survival to discharge occurred in 69 patients (65.7%), and 55 patients (52.4%) attained favorable neurological outcomes.
Initial shockable rhythm independently predicted survival (aOR, 5.38; 95% CI, 1.77–18.02; p=0.005) and favorable neurological outcomes (aOR, 11.02; 95% CI, 3.39–43.00; p<0.001).
Prehospital return of spontaneous circulation was independently associated with survival (aOR, 10.30; 95% CI, 3.62–33.06; p<0.001) and neurological recovery (aOR, 11.69; 95% CI, 3.69–45.03; p<0.001), while each additional minute of scene time interval decreased survival odds (aOR, 0.88; 95% CI, 0.79–0.98; p=0.025).

Study Design

Type

Cohort (n=105)

Multicenter

Yes

Structured PICO

Does initial shockable rhythm and prehospital ROSC predict survival and favorable neurological outcomes in patients with non-ST-elevation OHCA undergoing PCI?

P

Population

105 adult patients (median age 59 years, 13.3% female) with non-ST-elevation out-of-hospital cardiac arrest who survived to undergo percutaneous coronary intervention, assessed at hospital discharge.

E

Exposure

Presence of initial shockable rhythm and prehospital return of spontaneous circulation (ROSC) (assessed as prognostic factors)

C

Comparator

Absence of initial shockable rhythm and lack of prehospital ROSC

O

Outcome

Survival to hospital discharge and favorable neurological outcomes (cerebral performance category 1-2 at hospital discharge)hard clinical

Main Result

Odds Ratio: 5.38 (95% CI 1.77–18.02)

p-value: p=0.005

In patients with non-ST-elevation out-of-hospital cardiac arrest who undergo PCI, prognosis remains heavily stratified by prehospital factors such as initial shockable rhythm and prehospital ROSC, rather than procedural variables.

Limitations

Retrospective, single-city registry-based analysis with potential residual confounding from institutional variations in post-cardiac arrest care.
Inclusion required survival of sufficient duration to reach the catheterization laboratory and complete PCI, introducing survivorship bias.
The analysis was prognostic rather than predictive of treatment effects, as there was no comparator group of patients who did not undergo PCI.
Modest sample size produced wide confidence intervals.
Outcomes were assessed only at the time of hospital discharge, without post-discharge follow-up data.
Retrospective, single-city registry without a standardized protocol, introducing potential residual confounding.
Survivorship bias, as inclusion required survival of sufficient duration to reach the catheterization laboratory and complete PCI.
Prognostic rather than predictive analysis, lacking a non-PCI comparator group to determine treatment effects.
Modest sample size producing wide confidence intervals.
Outcomes assessed only at the time of hospital discharge, without long-term follow-up data.

Implication

Prognosis in non-ST-elevation OHCA patients undergoing PCI remains stratified by prehospital factors; leaves open the impact of procedural variables on outcomes.

Abstract

BACKGROUND: Although the timing and indications for coronary angiography (CAG) after out-of-hospital cardiac arrest (OHCA) have been widely studied, the characteristics associated with favorable outcomes in patients with non-ST-elevation (non-STE) undergoing percutaneous coronary intervention (PCI) remain unclear. METHODS: This retrospective cohort study used a citywide, prospectively collected OHCA registry in Daegu, Korea (2018-2022), which included adult patients with non-STE after OHCA who underwent both CAG and PCI. Given the limited number of outcome events relative to the covariates, Firth's penalized logistic regression identified factors independently associated with survival to hospital discharge and favorable neurological outcomes (cerebral performance category 1-2). RESULTS: Of the 5,026 patients treated by Emergency Medical Services for OHCA, 371 underwent CAG; 258 (69.5%) had no ST elevation on the initial electrocardiogram, and 105 (40.7%) underwent PCI and formed the study cohort. Sixty-nine patients (65.7%) survived to discharge, and 55 (52.4%) had favorable neurological outcomes. Initial shockable rhythm (adjusted odds ratio [aOR], 5.38; 95% confidence interval [CI], 1.77-18.02), prehospital return of spontaneous circulation (ROSC) (aOR, 10.30; 95% CI, 3.62-33.06), and shorter scene time interval (aOR, 0.88 per minute; 95% CI, 0.79-0.98) were independently associated with survival. Initial shockable rhythm (aOR, 11.02; 95% CI, 3.39-43.00) and prehospital ROSC (aOR, 11.69; 95% CI, 3.69-45.03) were independently associated with favorable neurological outcomes. CONCLUSION: Among patients with non-STE after OHCA who underwent CAG and PCI, initial shockable rhythm and prehospital ROSC were independently associated with survival and neurological outcomes, whereas shorter scene time interval was independently associated with only survival. Because the cohort was restricted to patients who survived to undergo PCI, these findings reflect prognostic stratification within an already treated group and cannot infer the benefits of CAG or PCI. Therefore, prospective confirmation is warranted.

Discussion

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Cite This Study

Shin et al. (2026) conducted a cohort in Non-ST-elevation out-of-hospital cardiac arrest (n=105). Initial shockable rhythm vs. Non-shockable rhythm was evaluated on Survival to hospital discharge (aOR 5.38, 95% CI 1.77-18.02, p=0.005). In patients with non-ST-elevation out-of-hospital cardiac arrest undergoing percutaneous coronary intervention, an initial shockable rhythm was independently associated with survival to hospital discharge (aOR 5.38).

synapsesocial.com/papers/6a9d1e4528139818eab20ff3 https://doi.org/10.12701/jyms.2026.43.62

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Shockable rhythm as an independent prognostic factor in patients with non-ST elevation undergoing percutaneous coronary intervention after out-of-hospital cardiac arrest: a registry-based cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Shockable rhythm as an independent prognostic factor in patients with non-ST elevation undergoing percutaneous coronary intervention after out-of-hospital cardiac arrest: a registry-based cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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