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Long-term survival after cardiac arrest in patients undergoing emergent coronary angiography
Pablo Vidal-Calés1, Luis Ortega-Paz2, Salvatore Brugaletta1
1Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Insights
Therapeutic hypothermia did not improve long-term survival in cardiac arrest patients undergoing coronary angiography. This study found similar mortality rates between hypothermia and no-hypothermia groups, with increased bleeding risk in the hypothermia group.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Emergency Medicine
Background:
- Cardiac arrest survivors undergoing emergent coronary angiography often receive therapeutic hypothermia.
- Long-term survival data for these patients are crucial for treatment guidelines.
- The efficacy of therapeutic hypothermia in improving long-term outcomes remains a subject of investigation.
Purpose of the Study:
- To determine the long-term survival rates of patients after cardiac arrest who underwent emergent coronary angiography and therapeutic hypothermia.
- To compare all-cause mortality at median follow-up between patients treated with and without therapeutic hypothermia.
- To evaluate periprocedural complications and 6-month all-cause death.
Main Methods:
- Analysis of data from a regional STEMI network (January 2015 - December 2020).
- Inclusion of 494 cardiac arrest patients, divided into groups with (n=119) and without (n=375) therapeutic hypothermia.
- Primary endpoint: all-cause mortality at median follow-up (16.0 months); secondary endpoints: periprocedural complications and 6-month mortality; landmark analysis at 6 months.
Main Results:
- No significant difference in adjusted all-cause mortality at median follow-up between hypothermia (51.3%) and no-hypothermia (48.0%) groups (HRadj 1.08; P=0.659).
- Higher frequency of bleeding complications in the hypothermia group (6.7% vs 1.1%; ORadj 7.99; P=0.002).
- Similar adjusted all-cause mortality at 6 months (46.2% vs 44.5%) and no significant difference in mortality between 6 months and median follow-up.
Conclusions:
- Therapeutic hypothermia did not improve long-term survival in this large cohort of cardiac arrest patients within a regional STEMI network.
- The findings suggest that therapeutic hypothermia may be associated with an increased risk of bleeding without conferring a survival benefit.
- Further research may be warranted to identify patient subgroups who could benefit from therapeutic hypothermia.
Aim:
To determine long-term survival of patients after cardiac arrest undergoing emergent coronary angiography and therapeutic hypothermia.
Methods:
We analysed data from patients treated within the regional STEMI Network from January 2015 to December 2020. The primary endpoint was all-cause mortality at median follow-up. Secondary endpoints were periprocedural complications (arrhythmias, pulmonary edema, cardiogenic shock, mechanical complication, stent thrombosis, reinfarction, bleeding) and 6-month all-cause death. A landmark analysis was performed, studying two time periods; 0-6 months and beyond 6 months.
Results:
From a total of 24,125 patients in the regional STEMI network, 494 patients who suffered from cardiac arrest were included and divided into two groups: treated with (n = 119) and without therapeutic hypothermia (n = 375). At median follow-up (16.0 [0.2-33.3] months), there was no difference in the adjusted mortality rate between groups (51.3 % with hypothermia vs 48.0 % without hypothermia; HRadj1.08 95%CI [0.77-1.53]; p = 0.659). There was a higher frequency of bleeding in the hypothermia group (6.7 % vs 1.1 %; ORadj 7.99 95%CI [2.05-31.2]; p = 0.002), without difference for the rest of periprocedural complications. At 6-month follow-up, adjusted all-cause mortality rate was similar between groups (46.2 % with hypothermia vs 44.5 % without hypothermia; HRadj1.02 95%CI [0.71-1.47]; p = 0.900). Also, no differences were observed in the adjusted mortality rate between 6 months and median follow-up (9.4 % with hypothermia vs 6.3 % without hypothermia; HRadj2.02 95%CI [0.69-5.92]; p = 0.200).
Conclusions:
In a large cohort of patients with cardiac arrest within a regional STEMI network, those treated with therapeutic hypothermia did not improve long-term survival compared to those without hypothermia.
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