Invasive Strategy Ups Out-of-Hospital Cardiac Arrest Survival

Emergency coronary angiography, successful PCI linked to survival for unconscious patients

WEDNESDAY, Dec. 26 (HealthDay News) -- For patients with out-of-hospital cardiac arrest (OHCA) who do not regain consciousness, an invasive strategy characterized by emergency coronary angiography and subsequent percutaneous coronary intervention (PCI), if indicated, is associated with improved in-hospital survival, according to a study published in the Dec. 15 issue of The American Journal of Cardiology.

Davide Zanuttini, M.D., of the Santa Maria della Misericordia University Hospital in Udine, Italy, and associates conducted a retrospective study involving 93 consecutive OHCA patients (76 percent men; mean age, 67 years). The authors sought to examine the impact of an invasive strategy on in-hospital survival of resuscitated patients with OHCA and no obvious extracardiac cause, who do not regain consciousness shortly after recovery of spontaneous circulation.

The researchers found that, of the 66 patients (71 percent) who underwent coronary angiography, 48 had emergency coronary angiography, and the mean time from OHCA to angiography was 13 days in the remaining 18 patients. Of those who underwent emergency coronary angiography, 52 percent underwent successful emergency PCI of a culprit coronary lesion. There was a 54 percent in-hospital survival rate. Emergency coronary angiography and successful emergency PCI correlated significantly with in-hospital survival (hazard ratios, 2.32 and 2.54, respectively). For patients referred to coronary angiography, a delay in performance was independently associated with in-hospital mortality (hazard ratio, 0.95; P = 0.013).

"In conclusion, an invasive strategy characterized by emergency coronary angiography and subsequent PCI, if indicated, seems to improve in-hospital outcome of resuscitated but unconscious patients with OHCA without obvious extracardiac cause," the authors write.

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