17 Nov Early PCI Valuable for Out-of-Hospital Cardiac Arrest
Medical Research: What is the background of the study? What are the main findings?
Dr. Geri: Culprit coronary artery occlusion is the main cause of out-of-hospital cardiac arrest. This has been well demonstrated since pioneer study of Spaulding et al in the New England Journal of Medicine in 1997. Several studies highlighted the favorable prognostic impact of an immediate successful PCI in cardiac arrest patients but inclusion biases or the lack of data on in-hospital management limit the generalization of such findings.
In this large French cohort of out-of-hospital cardiac arrest patients who were admitted after successful return of spontaneous circulation from 2000 to 2012, those who received immediate PCI had better short- and long-term survival than those who did not undergo the procedure, new data presented here concluded.
The researchers examined the association between immediate PCI and survival at 30 days, 2 years and 10 years, and evaluated other potential predicting factors. Furthermore, they used a propensity score method to analyze the impact of PCI on 30-day and long-term survival in matched patients.
Overall, 1,722 patients (71.5% male; median age, 59.9 years) were analyzed during a median 2 year follow-up. OHCA (out-of-hospital cardiac arrest ) was witnessed in 86.7% of patients, and occurred in a public space in 32.2% of patients and with an initial shockable rhythm (eg, ventricular fibrillation/ventricular tachycardia) in 54.6% of cases.
Therapeutic hypothermia was utilized in 71% of patients whereas immediate PCI was performed in 27.8% of patients.
At 30 days, survival was higher in the immediate PCI group compared with those who did not undergo the procedure (43% vs. 27.5%), which remained consistent at 2 years (40.1% vs. 23.4%) and 10 years (38% vs. 20.2%). Immediate PCI also yielded better survival at 30 days (adjusted OR=0.71; P=.02) and during the long term (adjusted HR=0.44; P<.01).
Similarly, among the propensity score matched cohort, long-term survival was better in the PCI arm (adjusted HR=0.29; 95% CI, 0.14-0.61).
Medical Research: What is the take home message?
Dr. Geri: Early coronary angiography and PCI if required should be considered in all non-trauma out of hospital cardiac arrest patients without an obvious extra- cardiac cause.