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Emergent PCI after out-of-hospital cardiac arrest linked to better outcomes
In patients resuscitated from an out-of-hospital cardiac arrest without ST-segment elevation pattern, emergent PCI appears to be associated with favorable outcomes at hospital discharge, particularly among men aged older than 50 years with initially shockable rhythm, according to new findings from the PROCAT study.
Researchers evaluated 958 patients admitted to an ICU with out-of-hospital cardiac arrest and whose cases were documented in the PROCAT database between 2004 and 2013. Patients underwent an emergent coronary angiogram on admission.
In 695 of the 958 patients, the postresuscitation ECG revealed no evidence of ST-segment elevation. Of these patients, 66% were men, with a mean age of 60 years. Patient information was entered in the database and included age, sex, CV risk factors, location of cardiac arrest and initial cardiac rhythm. Based on coronary angiographic findings, PCI was attempted in cases where a coronary artery occlusion or a culprit coronary lesion was identified. After PCI, the procedure was considered successful if it yielded residual stenosis < 50% with TIMI grade 3 flow.
The primary outcome of this study was the highest level on the Cerebral Performance Category (CPC) scale documented at hospital discharge by the physician in charge, with CPC1 and CPC2 deemed favorable outcomes.
Overall, 36% of the 695 patients achieved a favorable outcome rate at hospital discharge. Patients who underwent successful PCI had better outcomes, with 85 of 199 (43%) achieving a positive outcome compared with 166 of 496 (33%) patients who were not treated with emergent PCI after coronary angiogram (P = .02). Adjustment for potential confounders revealed an independent association between emergent successful PCI and better outcome (adjusted OR = 1.8; 95% CI, 1.09-2.97). This correlation persisted after adjustment based on the year of inclusion (adjusted OR = 1.8; 95% CI, 1.09-2.99). Other factors associated with better outcome included shorter resuscitation length (< 20 minutes), an initial shockable rhythm and a low dose of epinephrine (P < .001). The following baseline patient characteristics were associated with PCI: male sex, smoking and initial shockable rhythm (P < .05). Culprit coronary lesions were identified in 30.2% of patients aged older than 50 years, whereas 22.6% of patients younger than 50 years presented with culprit coronary lesions (P = .07). After adjustment for early potential confounders, initial shockable rhythm was the only predictor of successful PCI (adjusted OR = 2.83; 95% CI, 1.84-4.36). Men aged older than 50 years with an initial shockable rhythm needed PCI in nearly 40% of cases.
atients without [ST-segment elevation] on the postresuscitation ECG after out-of-hospital cardiac arrest,” the researchers wrote. “Older men resuscitated from an initially shockable rhythm mostly benefited from this strategy. In the absence of randomized trials, the present results support the use of an emergent invasive strategy in this specific population and may help to select the best candidates.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.