Immediate coronary angiogram in comatose survivors of out-of-hospital cardiac arrest--an Australian study.

INTRODUCTION: The role of immediate coronary angiography and percutaneous coronary intervention (angio±PCI), amongst comatose survivors of out-of-hospital cardiac arrest is unclear. This study was undertaken to evaluate if immediate angio±PCI compared to no initial intervention improves neurological outcome at hospital discharge amongst comatose survivors of out-of-hospital pulseless ventricular tachycardia (pVT) or ventricular fibrillation (VF).
METHODS: All patients admitted to Intensive Care Unit (ICU) following an out-of-hospital VF/pVT arrest from 1/1/2003 to 31/12/2008 were included. Outcome of patients who underwent immediate angio±PCI was compared to those who did not undergo any intervention before admission to ICU. Good outcome was defined as survival to hospital discharge with Cerebral Performance Category (CPC) score of 1 or 2.
RESULTS: Thirty-five patients (30 Males, 5 Females, mean age 60.3±10.1), underwent angio±PCI prior to ICU admission. A further 35 patients (20 Males, 15 Females, mean age 61.1±17.6 years) were admitted directly to ICU without undergoing any intervention. Forty percent (14/35) of patients who had immediate coronary intervention survived to hospital discharge with a good outcome compared to 31% (11/35) patients who did not undergo any intervention. After adjusting for other covariates, the probability of good outcome at hospital discharge was related to severity of illness (SAPS-II) score at ICU admission (adj OR=0.87, 95% CI 0.81-0.94, p<0.01). Immediate angio±PCI compared to no intervention was associated with an improved outcome but this difference was statistically not significant (adj OR 1.32, 95% CI 0.26-7.87, p=0.78).
CONCLUSION: Immediate angio±PCI in comatose survivors of out-of-hospital VF/pVT arrest did not lead to better neurological outcome at hospital discharge. Crown