Abstract P177: The Relationship between Out-of-Hospital Cardiac Arrest Due to cardiac Etiology and Medical History of Cardiovascular Disease
BACKGROUND Sudden cardiac arrest is a leading cause of death in the world. Although a strong chain of survival has improved outcomes, few data of medical history are available for patients with out-of-hospital cardiac arrest.
METHODS We investigated the relationship between cardiovascular medical histories and incidence of out-of-hospital cardiac arrest due to cardiac etiology from the SOS-KANTO study (Lancet 2007; 369). A total of 9,232 adult patients whose medical histories at the time of cardiac arrest were recorded were divided into 2 groups according to the Utstein style reporting guidelines (cardiac arrest due to cardiac etiology group vs. non-cardiac etiology group).
RESULTS Of the 9,232 patients, 5,785 (63%) were caused by cardiac etiology. Of those 5,785 patients, 45% had the medical histories with cardiovascular disease including 17.4% hypertension, 14.9% diabetes, 12.4% ischemic heart disease, 8.7% cerebrovascular disease and 4.5% heart failure. The cardiac etiology group had significantly higher proportions of the total cardiovascular medical histories and each cardiovascular medical history without cerebrovascular disease than the non-cardiac etiology group. The adjusted hazard ratio for cardiac arrest due to cardiac etiology after heart failure was 5.1 (95%CI; 3.5 to 7.3), after ischemic heart disease; 5.0 (95%CI; 4.0 to 6.2), after diabetes; 2.1 (95%CI; 1.8 to 2.5), and after hypertension; 1.4 (95%CI; 1.3 to 1.6). Furthermore, the adjusted hazard ratio was after 1 cardiovascular medical history was 2.0 (95%CI; 1.8 to 2.2), after 2 histories; 2.9 (95%CI; 2.4 to 3.6), after 3 or more histories; 5.3 (95%CI; 3.2 to 9.1). Especially, incidence of cardiac arrest in patients with medical history of diabetes plus ischemic heart disease or heart failure was more than 10 times higher than that with no cardiovascular medical history.
CONCLUSIONS Each cardiovascular medical history was associated with an increasing incidence of out-of-hospital cardiac arrest due to cardiac etiology, and the incidence increased in a stepwise fashion among patients in increasing number of cardiovascular medical histories. Especially, the overlaps of diabetes plus ischemic heart disease or heart failure were high risk factors of out-of-hospital cardiac arrest.