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Published on: January 28, 2020
Coronary angiography predicts improved outcome following cardiac arrest: propensity-adjusted analysis
Joshua C Reynolds1, Clifton W Callaway, Samar R El Khoudary
1Department of Emergency Medicine, University of Maryland, Baltimore, Maryland, USA.
Insights
Coronary angiography (CATH) in cardiac arrest survivors identifies significant blockages and is independently linked to better outcomes, even without initial ECG changes. This procedure aids in predicting patient recovery after cardiac arrest.
Area of Science:
- Cardiology
- Emergency Medicine
- Critical Care
Background:
- Coronary angiography (CATH) improves survival in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation/ventricular tachycardia (VF/VT).
- The impact of CATH on outcomes in other cardiac arrest patient groups remains unclear.
Purpose of the Study:
- To determine if clinical factors in resuscitated cardiac arrest patients predict CATH performance.
- To assess if undergoing CATH after cardiac arrest is associated with improved patient outcomes.
Main Methods:
- A retrospective chart review of 241 resuscitated cardiac arrest patients from 2005-2007.
- Logistic regression was used to identify predictors of CATH and assess its association with good outcomes, adjusting for propensity scores.
Main Results:
- Of 241 patients, 96 (40%) received CATH. Significant coronary artery stenosis (≥70%) was found in 69% of patients, including 57% without acute ischemic ECG changes.
- Unadjusted predictors for CATH included sex, arrival method, OHCA, presenting rhythm, ECG changes, and Glasgow Coma Scale (GCS).
- Propensity-adjusted analysis showed CATH was independently associated with a good outcome (OR 2.16; 95% CI 1.12-4.19).
Conclusions:
- CATH is more frequently performed in specific patient profiles following cardiac arrest.
- The procedure effectively identifies significant coronary artery disease in this population.
- Receiving CATH was independently associated with favorable patient outcomes.
Objectives:
Determine if clinical parameters of resuscitated patients predict coronary angiography (CATH) performance and if receiving CATH after cardiac arrest is associated with outcome.
Introduction:
CATH is associated with survival in patients suffering out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation or ventricular tachycardia(VF/VT). Its effect on outcome in other cohorts is unknown.
Methods:
Chart review of resuscitated cardiac arrest patients between 2005 and 2007.
Exclusion Criteria:
immediate withdrawal of care, hemodynamic collapse, or neurologic exam under sedation. Clinical parameters included Glasgow Coma Scale (GCS) arrest location, presenting rhythm, age, and acute ischemic ECG changes (new left bundle branch block or ST-elevation myocardial infarction-STEMI). Logistic regression identified clinical parameters predicting CATH. The association between CATH and good outcome (discharge home or to acute rehabilitation facility) was determined using logistic regression adjusting for likelihood of receiving CATH via propensity score.
Result:
Of the 241 patients, 96 (40%) received CATH. Significant disease (>or=70% stenosis) of >or=1 coronary arteries was identified in 69% of patients including 57% of patients without acute ischemic ECG changes. Unadjusted predictors of CATH were sex, method of arrival, OHCA, presenting rhythm, acute ischemic ECG changes, and GCS. Propensity adjusted logistic regression demonstrated an association between CATH and good outcome (OR 2.16; 95% CI 1.12, 4.19; P<0.02).
Conclusion:
CATH is more likely to be performed in certain patients and identifies a significant number of high-grade stenoses in this population. Receiving CATH was independently associated with good outcome.
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