19 Sep JAMA Study Finds More Interventions and Increasing Survival After Out-of-Hospital Cardiac Arrests
MedicalResearch.com Interview with:
Nish Patel, MD and Nileshkumar J. Patel, MD
University of Miami Miller School of Medicine
MedicalResearch.com: What is the background for this study?
Response: Out of hospital cardiac arrest (OHCA) is estimated to affect approximately 300,000 people in the United States annually. Pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) contributes 23-54% of OHCA patients, with the median values at the lower end of this range. Coronary artery disease is thought to be responsible for up to 70% of these OHCA cases.
It has been suggested that urgent coronary intervention in unconscious patients after cardiac arrest may improve survival. In the 2015 American Heart Association (AHA) guidelines, coronary angiography is recommended in patients with OHCA patients with a suspected cardiac etiology and ST elevations (STE) on ECG (Class of recommendation I, Level of evidence B), and it should be considered in patients after cardiac arrest presenting without STE but with suspected cardiac etiology of cardiac arrest (Class of recommendation II a, Level of evidence B). However, there is paucity of information about the use of coronary angiography and percutaneous coronary intervention (PCI) and its potential benefit for the VT/VF OHCA patient population.
Therefore, we reviewed the Nationwide Inpatient Sample (NIS), to examine temporal trends of coronary angiography and PCI in VT/VF OHCA in the United States, for patients with and without STE. We also studied the temporal trends of survival to discharge in these patient populations.
MedicalResearch.com: What are the main findings?
Response: Of 407,974 patients with VT/VF OHCA, 143,688 (35.2%) underwent coronary angiography. Use of coronary angiography increased from 27.2% in 2000 to 43.9% 2012 (P trend <0.001) and percutaneous coronary intervention (PCI) increased from 9.5% in 2000 to 24.1% in 2012 (P trend <0.001). Between 2000 and 2012, coronary angiography and PCI after VT/VF OHCA increased both in patients with STE (53.7% to 87.2% [P trend <0.001] and 29.7% to 77.3% [P trend <0.001], respectively) and those without STE (19.3% to 33.9% [P trend <0.001] and 3.5% to 11.8% [P trend <0.001], respectively).
There was an associated increasing trend in survival to discharge in the overall VT/VF OHCA patient population (46.9% to 60.1% [Ptrend <0.001]), both with STE (59.2% to 74.3% [P trend <0.001]) or without STE (43.3% to 56.8% [P trend < 0.001]).
MedicalResearch.com: What should readers take away from your report?
Response: Among patients hospitalized with VT/VF OHCA between 2000 and 2012 in U.S. hospitals participating in NIS, the use of coronary angiography and PCI has progressively increased. These increases were observed in VT/VF OHCA patients with and without STE. There was an association with increased survival to discharge and survival to discharge home in the overall VT/VF OHCA patient population regardless of the presence of STE in the initial ECG.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Prospective randomized outcome trials should be undertaken to address the potential value of broader coronary angiography and PCI use as a part of post resuscitation care in the VT/VF OHCA patient population.
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