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Multivessel versus Culprit-Only Revascularization Strategies in Cardiac Arrest Survivors
Wei-Ting Chen1, Min-Shan Tsai1, Chien-Hua Huang1
1Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei.
Insights
Multivessel revascularization reduced in-hospital mortality in cardiac arrest survivors with multivessel coronary artery disease compared to culprit-only revascularization. This benefit was particularly evident in patients with prolonged resuscitation times.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- The optimal revascularization strategy for cardiac arrest survivors with multivessel coronary artery disease is not well-defined.
- Current guidelines do not definitively favor multivessel over culprit-only revascularization in this patient population.
Purpose of the Study:
- To retrospectively evaluate the association between multivessel revascularization and culprit-only revascularization with in-hospital mortality in cardiac arrest survivors presenting with multivessel coronary artery disease.
Main Methods:
- Retrospective analysis of 273 cardiac arrest survivors undergoing emergent coronary angiography within 24 hours.
- 90 patients with multivessel coronary artery disease were analyzed, divided into multivessel (n=45) and culprit-only (n=45) revascularization groups.
- In-hospital mortality and neurological outcomes were compared between the two groups.
Main Results:
- Multivessel revascularization was associated with significantly lower in-hospital mortality (37.8% vs. 55.6%; adjusted HR=0.47, p=0.035).
- The survival benefit of multivessel revascularization was more pronounced in patients with prolonged cardiopulmonary resuscitation (>10 min) (adjusted HR=0.27, p=0.03).
- No significant difference in neurological outcomes was observed between the groups (adjusted OR=1.22, p=0.753).
Conclusions:
- Multivessel revascularization appears to be associated with reduced in-hospital mortality in cardiac arrest survivors with multivessel coronary artery disease.
- The findings suggest a potential benefit of a more comprehensive revascularization approach in select cardiac arrest survivors.
- Further prospective studies are warranted due to the observational nature and small sample size of this study.
Background:
Whether multivessel revascularization or culprit-only revascularization is more beneficial in cardiac arrest survivors with multivessel coronary artery disease remains unclear. We aimed to retrospectively evaluate whether multivessel or culprit-only revascularization following cardiac arrest was associated with a reduced incidence of in-hospital mortality.
Methods:
A total of 273 adult nontraumatic cardiac arrest survivors (aged ≥ 18 years) who underwent emergent coronary angiography (CAG) within 24 h following cardiac arrest were retrospectively recruited from three hospitals. Patients without definite coronary artery stenosis (n = 72), one-vessel stenosis (n = 74), or failed percutaneous coronary intervention (PCI; n = 37) were excluded. A total of 90 patients were enrolled for the final analysis and classified into multivessel (revascularization of more than one major vessel during the index CAG; n = 45) and culprit-only (revascularization of the infarct-related artery alone; n = 45) groups.
Results:
Twenty-five patients (55.6%) in the culprit-only group and 17 patients (37.8%) in the multivessel group failed to survive to discharge [adjusted hazard ratio (HR) = 0.47, 95% confidence interval (CI) = 0.24-0.95, p = 0.035]. The benefit of multivessel revascularization on survival was obvious among those with a prolonged cardiopulmonary resuscitation duration (> 10 min) (47.82% vs. 76.92%, adjusted HR = 0.27, 95% CI = 0.08-0.93, p = 0.03). No difference in neurological outcomes (favorable = cerebral performance category scores 1-2; poor = 3-5) between groups was observed (60.0% vs. 55.6%, adjusted OR = 1.22, 95% CI = 0.35-4.26, p = 0.753).
Conclusions:
Compared with culprit-only revascularization, multivessel revascularization was associated with lower in-hospital mortality among cardiac arrest survivors with multivessel lesions. Owing to the retrospective design and small sample size, the current study should be interpreted as observational and exploratory.
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