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Non-Traumatic Out-of-Hospital Cardiac Arrest at Fiona Stanley Hospital: In-Hospital Mortality Predictors and Timing
Hendry Ramly1, David Manners2, Jenny Luong1
1Department of Cardiology Medicine, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia.
Insights
Delayed coronary angiography (CAG) in out-of-hospital cardiac arrest (OHCA) patients with non-ST-elevation myocardial infarction may improve survival. Immediate or intermediate CAG was linked to higher mortality, suggesting a selective approach is beneficial.
Area of Science:
- Cardiology
- Emergency Medicine
- Critical Care
Background:
- Out-of-hospital cardiac arrest (OHCA) is a major cause of death.
- The optimal timing for coronary angiography (CAG) in OHCA survivors with non-ST-elevation myocardial infarction (NSTEMI) is unclear.
- Current guidelines offer limited guidance on urgent CAG for OHCA patients.
Purpose of the Study:
- To evaluate the impact of CAG timing on in-hospital mortality and neurological outcomes in non-traumatic OHCA patients.
- To identify clinical predictors of poor prognosis in this patient group.
Main Methods:
- Retrospective cohort study of 223 non-traumatic OHCA patients (February 2015 - December 2022).
- Patients categorized into immediate (<2 hours), intermediate (2-24 hours), and delayed (>24 hours) CAG groups.
- Multivariate logistic regression used to identify predictors of mortality and neurological outcomes.
Main Results:
- Higher in-hospital mortality observed in patients receiving immediate or intermediate CAG compared to delayed CAG.
- Delayed CAG was associated with improved survival outcomes.
- Independent predictors of mortality included lower pH, lower systolic blood pressure, lower Glasgow Coma Scale score, and diabetes.
Conclusions:
- Routine immediate CAG is not supported for OHCA patients with NSTEMI.
- A selective, delayed CAG strategy after hemodynamic stabilization may enhance patient survival.
- Prioritizing stabilization before CAG is crucial, with pH, systolic blood pressure, and GCS serving as key prognostic indicators.
Background & Aim:
Out-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality, with uncertain benefits of urgent coronary angiography (CAG) in non-ST-elevation myocardial infarction cases. Current guidelines lack clarity on the optimal timing of CAG for OHCA survivors. This study investigates the impact of CAG timing on in-hospital mortality and neurological outcomes in non-traumatic OHCA patients. It also identifies clinical predictors of poor prognosis.
Method:
A retrospective cohort study was conducted at Fiona Stanley Hospital, Western Australia, analysing 223 non-traumatic OHCA patients admitted between February 2015 and December 2022. Patients were categorised into three CAG timing groups: immediate (<2 hours), intermediate (2-24 hours), and delayed (>24 hours). Multivariate logistic regression was used to assess independent predictors of mortality and neurological outcomes.
Results:
Mortality was significantly higher in patients who received immediate or intermediate CAG compared to those who received delayed CAG. Delayed CAG was associated with better survival. Independent predictors of in-hospital mortality included lower pH, lower systolic blood pressure, lower Glasgow Coma Scale score on arrival, and diabetes.
Conclusions:
Our findings do not support routine immediate CAG in non-ST-elevation myocardial infarction OHCA. A selective, delayed approach after hemodynamic stabilisation may improve survival. Clinicians should prioritise stabilisation before CAG, using pH, systolic blood pressure, and Glasgow Coma Scale as key prognostic indicators.
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