Routine Angiography in Survivors of Out of Hospital Cardiac Arrest With Return of Spontaneous Circulation: A Single Site Registry

BMC Cardiovasc Disord. 2014 Mar 3;14:30. doi: 10.1186/1471-2261-14-30.

Abstract

Background: Coronary revascularization in resuscitated out of hospital cardiac arrest (OOHCA) patients has been associated with improved survival.

Methods: This was a retrospective review of patients with OOHCA between 01/07/2007 and 31/03/2009 surviving to hospital admission. Cardiac risk factors, demographics, treatment times, electrocardiogram (ECG), angiographic findings and in-hospital outcomes were recorded.

Results: Of the 78 patients, 63 underwent coronary angiography. Traditional cardiac risk factors were common in this group. Chest pain occurred in 33.3% pre-arrest, 59.0% were initially treated at a peripheral hospital, 83.3% had documented ventricular tachycardia or ventricular fibrillation, 55.1% had specific ECG changes, 65.4% had acute myocardial infarction (AMI) as the cause of OOHCA and the majority had multi-vessel disease. ST elevation strongly predicted AMI. The in-hospital survival was 67.9% with neurological deficit in 13.2% of survivors. The group of patients who had an angiogram were more likely to have AMI as a cause of cardiac arrest (71.4% vs 40.0%, p = 0.01) and more likely to have survived to discharge (74.6% vs 40.0%, p < 0.01). Poor outcome was associated with older age, cardiogenic shock, longer transfer times, diabetes, renal impairment and a long duration to return of spontaneous circulation.

Conclusions: Acute myocardial infarction was the commonest cause of OOHCA and a high rate of survival to discharge was seen with a strategy of routine angiography and revascularization.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Arrhythmias, Cardiac / complications
  • Arrhythmias, Cardiac / therapy
  • Blood Circulation*
  • Coronary Angiography*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / therapy
  • Electrocardiography
  • Female
  • Hospital Mortality
  • Humans
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / complications
  • Myocardial Infarction / therapy
  • Myocardial Revascularization
  • Out-of-Hospital Cardiac Arrest / diagnostic imaging*
  • Out-of-Hospital Cardiac Arrest / etiology
  • Out-of-Hospital Cardiac Arrest / physiopathology
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Patient Admission
  • Patient Discharge
  • Predictive Value of Tests
  • Queensland
  • Recovery of Function
  • Registries
  • Resuscitation*
  • Retrospective Studies
  • Risk Factors
  • Survivors*
  • Time Factors
  • Transportation of Patients
  • Treatment Outcome
  • Young Adult