Coronary angiography findings in relation to defibrillation refractoriness in out-of-hospital cardiac arrest - A nationwide study over 10 years

Abstract

Background: Severe coronary artery disease has been suggested as the main cause of out-of-hospital cardiac arrest (OHCA) requiring high number of defibrillations. We investigated the association between an increased degree of treatment refractoriness, defined as an increase in the number of defibrillation attempts, to coronary angiography findings and PCI in OHCA.

Methods: We included all OHCA patients in Sweden, 18-80 years old, with initial shockable rhythm during January 1, 2010, and December 31, 2019, who underwent coronary angiography. Patients were stratified by the number of defibrillations: 1-3, 4-6, 7-9, and ≥10, coronary angiography findings and interventions were described.

Results: In total, 3282 patients (19 % women, median age 64 years old) were included. Most patients had at least one significant stenosis, 80-67 %, with the highest proportions among those receiving 1-3 defibrillations. Acute coronary occlusions were present in similar proportions between the groups, 30-34 %. The proportion of patients receiving PCI was highest in the group with 1-3 defibrillations (68 %) and declined for those receiving more than 3 defibrillations, 57-52 %. There was a negative association between 1-year survival and increased number of defibrillations (75-39 %; p < 0.001), a difference unaffected when adjusting for coronary angiography findings and PCI in an adjusted multivariable model.

Conclusions: In this nationwide study including all OHCA patients undergoing coronary angiography during a ten-year period, we can show that defibrillation attempts is not related to the burden of coronary artery disease and does not aid in selecting patients for coronary angiography following OHCA.

Keywords: Coronary angiography; Out-of-hospital cardiac arrest; Refractory cardiac arrest.