Abstract P88: Early Coronary Angiography Predicts Improved Outcome Following Cardiac Arrest: Propensity-Adjusted Analysis
Introduction: Coronary angiography (CATH) is associated with survival in patients suffering out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation or ventricular tachycardia (VF/VT). It is unknown if CATH is associated with outcome for undifferentiated cardiac arrest patients. This study tested the hypotheses that demographic and clinical features of resuscitated patients predict performance of CATH and that receiving CATH was independently associated with improved outcome.
Methods: Chart review of consecutive adult patients resuscitated from non-traumatic cardiac arrest presenting between 2005 and 2007. Exclusion criteria were immediate withdrawal of care, hemodynamic collapse, or first neurologic exam under sedation. Clinical parameters included neurologic status (measured by Glasgow Coma Scale- GCS), arrest location, rhythm, age, and acute ischemic ECG changes (new left bundle branch block or STEMI). Logistic regression identified baseline demographic and clinical variables predicting CATH. The association between CATH and good outcome (defined as discharge home or to acute rehabilitation facility) was determined using logistic regression adjusting for the likelihood of receiving CATH via propensity-adjusted score quartiles.
Results: The mean age of the 241 patients was 60.6 years (SD 15.9). Fifty-five percent were male (n= 134) and 56% had OHCA (n=135). Presenting rhythm was VF/VT in 93 patients (39%), pulseless electrical activity (PEA) in 74 (31%), asystole in 52 (22%), and unknown in 22 (9%). Among the 40% receiving CATH (n=96), significant stenosis (>70%) of one or more coronary arteries was identified in 69% of patients including 57% of patients without ECG signs of acute ischemia. Unadjusted predictors of CATH were sex, method of arrival, OHCA, presenting rhythm, acute ischemic ECG changes and GCS. Overall, propensity adjusted logistic regression demonstrated receiving CATH as increasing the likelihood of a 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 is associated with a two-fold increase in the likelihood of good outcome after cardiac arrest.