Guillaume Geri1, Florence Dumas1, Wulfran Bougouin1, Olivier Varenne1, Fabrice Daviaud1, Frédéric Pène1, Lionel Lamhaut1, Jean-Daniel Chiche1, Christian Spaulding1, Jean-Paul Mira1, Jean-Philippe Empana1, Alain Cariou2. 1. From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.). 2. From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.). Alain.cariou@cch.aphp.fr.
Abstract
BACKGROUND: Whether to perform or not an immediate percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest is still debated. We aimed to evaluate the impact of PCI on short- and long-term survival in out-of-hospital cardiac arrest patients admitted after successful resuscitation. METHODS AND RESULTS: Between 2000 and 2013, all nontrauma out-of-hospital cardiac arrest patients admitted in a Parisian cardiac arrest center after return of spontaneous circulation were prospectively included. The association between immediate PCI and short- and long-term mortality was analyzed using logistic regression and Cox multivariate analysis, respectively. Propensity score-matching method was used to assess the influence of PCI on short- and long-term survival. During the study period, 1722 patients (71.5% male, median age 60 [49.6, 72.2] years) were analyzed: 628 (35.6%) without coronary angiography, 615 (35.7%) with coronary angiography without PCI, and 479 (27.8%) with both. Among these groups, day 30 and year-10 survival rates were 21% and 11.9%, 35% and 29%, 43% and 38%, respectively (P<0.01 for each). PCI as compared with no coronary angiography was associated with a lower day-30 and long-term mortality (adjORcoro with PCI versus no coro 0.71, 95% confidence interval [0.54, 0.92]; P=0.02 and adjHRcoro with PCI versus no coro 0.44, 95% confidence interval [0.27, 0.71]; P<0.01, respectively). PCI remained associated with a lower risk of long-term mortality (adjHR 0.29; 95% confidence interval [0.14, 0.61]; P<0.01) in propensity score-matching analysis. CONCLUSIONS: Immediate PCI after out-of-hospital cardiac arrest was associated with significant reduced risk of short- and long-term mortality. These findings should suggest physicians to consider immediate coronary angiography and PCI if indicated in these patients.
BACKGROUND: Whether to perform or not an immediate percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest is still debated. We aimed to evaluate the impact of PCI on short- and long-term survival in out-of-hospital cardiac arrestpatients admitted after successful resuscitation. METHODS AND RESULTS: Between 2000 and 2013, all nontrauma out-of-hospital cardiac arrestpatients admitted in a Parisian cardiac arrest center after return of spontaneous circulation were prospectively included. The association between immediate PCI and short- and long-term mortality was analyzed using logistic regression and Cox multivariate analysis, respectively. Propensity score-matching method was used to assess the influence of PCI on short- and long-term survival. During the study period, 1722 patients (71.5% male, median age 60 [49.6, 72.2] years) were analyzed: 628 (35.6%) without coronary angiography, 615 (35.7%) with coronary angiography without PCI, and 479 (27.8%) with both. Among these groups, day 30 and year-10 survival rates were 21% and 11.9%, 35% and 29%, 43% and 38%, respectively (P<0.01 for each). PCI as compared with no coronary angiography was associated with a lower day-30 and long-term mortality (adjORcoro with PCI versus no coro 0.71, 95% confidence interval [0.54, 0.92]; P=0.02 and adjHRcoro with PCI versus no coro 0.44, 95% confidence interval [0.27, 0.71]; P<0.01, respectively). PCI remained associated with a lower risk of long-term mortality (adjHR 0.29; 95% confidence interval [0.14, 0.61]; P<0.01) in propensity score-matching analysis. CONCLUSIONS: Immediate PCI after out-of-hospital cardiac arrest was associated with significant reduced risk of short- and long-term mortality. These findings should suggest physicians to consider immediate coronary angiography and PCI if indicated in these patients.
Authors: Patrick J Coppler; Kelly N Sawyer; Chun Song Youn; Seung Pill Choi; Kyu Nam Park; Young-Min Kim; Joshua C Reynolds; David F Gaieski; Byung Kook Lee; Joo Suk Oh; Won Young Kim; Hyung Jun Moon; Benjamin S Abella; Jonathan Elmer; Clifton W Callaway; Jon C Rittenberger Journal: Ther Hypothermia Temp Manag Date: 2016-07-15 Impact factor: 1.286
Authors: Bryn E Mumma; Machelle D Wilson; María F García-Pintos; Pablo J Erramouspe; Daniel J Tancredi Journal: Resuscitation Date: 2018-12-24 Impact factor: 5.262
Authors: Miguel A Maturana; Charles F Clinton; Selene Caballero-Cummings; Brandon Cave; Amal Khan; Amit Nanda; Devarshi Ardeshna; Joel Raja; Rami N Khouzam Journal: Ann Transl Med Date: 2019-09
Authors: Timothy N Jones; Matthew Kelham; Krishnaraj S Rathod; Charles J Knight; Alastair Proudfoot; Ajay K Jain; Andrew Wragg; Muhiddin Ozkor; Paul Rees; Oliver Guttmann; Andreas Baumbach; Anthony Mathur; Daniel A Jones Journal: Am J Cardiovasc Dis Date: 2021-12-15