Predicting factors for long-term survival in patients with out-of-hospital cardiac arrest – a propensity score-matched analysis

Background Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death worldwide, with acute coronary syndromes accounting for most of the cases. While the benefit of early revascularization has been clearly demonstrated in patients with ST-segment-elevation myocardial infarction (STEMI), diagnostic pathways remain unclear in the absence of STEMI. We aimed to characterize OHCA patients presenting to 2 tertiary cardiology centers and identify predicting factors associated with survival. Methods We retrospectively analyzed 519 patients after OHCA from February 2003 to December 2017 at 2 centers in Munich, Germany. Patients undergoing immediate coronary angiography (CAG) were compared to those without. Propensity score (PS) matching analysis and multivariate regression analysis were performed to identify predictors for improved outcome. Results Immediate CAG was performed in 385 (74.1%) patients after OHCA with presumed cardiac cause of arrest. As a result of multivariate analysis after propensity score matching, we found that ROSC at admission and immediate CAG were associated with better 30-days-survival [(OR, 6.54; 95% CI, 2.03-21.02), (OR, 2.41; 95% CI, 1.04-5.55)], and 1-year-survival [(OR, 4.49; 95% CI, 1.55-12.98), (OR, 2.54; 95% CI, 1.06-6.09)]. Conclusions In our study, ROSC at admission and immediate CAG were independent predictors of survival in cardiac arrest survivors. Improvement in prehospital management including bystander CPR and best practice post-resuscitation care with optimized triage of patients to an early invasive strategy may help ameliorate overall outcome of this critically-ill patient population.