Abstract 61: Acute Cardiac Catheterization in Survivors of Sudden Cardiac Arrest due to Ventricular Fibrillation is Associated with Improved Survival
Background: Acute coronary lesions are present in patients with sudden cardiac arrest (SCA) between 10 and 90% in autopsy series, and chronic stenotic lesions are also present. Despite a report of patients with resuscitated SCA (rSCA) receiving acute catheterization, the efficacy of this strategy remains unknown. We hypothesized that acute cardiac catheterization of patients with rSCA would improve survival to hospital discharge.
Methods: A retrospective cohort of 240 patients with out-of-hospital rSCA due to ventricular tachycardia or fibrillation was identified from 11 institutions in Seattle, Washington, between 1999 and 2002. Patients were grouped into those receiving acute catheterization within 6 hours (Group A, n = 61), and those either receiving delayed catheterization at greater than 6 hours, or those not receiving catheterization during the index hospitalization (Group B, n = 179). Outcome measures were survival to hospital discharge, neurologic status, extent of coronary artery disease (CAD), presenting electrocardiographic (ECG) findings, and pre-arrest symptomatology.
Results: 46/61 (75%) survived in Group A, whereas 87/179 (49%) survived in Group B (p < 0.001). Neurologic status mirrored this pattern. Percutaneous coronary intervention (PCI) was performed in 38/61 (62%) of patients in Group A, and 13/42 (31%) in Group B who received delayed catheterization (p = 0.002 by Chi-square). Multivariate propensity scoring revealed that age, bystander CPR, daytime presentation, history of percutaneous coronary intervention, neurologic disease, and ST elevation were all positively associated with receiving cardiac catheterization (Table 1⇓).
Conclusions: Acute cardiac catheterization was associated with higher survival in patients with rSCA. This may be in part due to increased utilization of PCI in this population, however, selection bias is also a likely factor.