Abstract 2694: Should we Perform More Coronary Interventions in Patients with Sudden Cardiac Arrest? Cardiac Arrest and Acute Coronary Intervention in Sweden
Background Sudden cardiac arrest (SCA) accounts for ~10 –15 % of the total mortality in the United States and other industrialized countries. In Sweden, there are ~10 000 cases of out-of-hospital SCA each year. In ~4000 cases resuscitation treatment is initiated by ambulance personnel and ~800 (20%) of these patients are hospitalized after the initial treatment. The aim of this prospective multicenter registry study was to investigate to which extent SCA patients are subjected to acute coronary interventions after successful cardiopulmonary resuscitation.
Methods Using data from the Swedish Cardiac Arrest Registry and Swedish Coronary Angiography and Angioplasty Registry, we analyzed all registered cases of coronary angiography and percutaneous coronary interventions from January 2005 to December 2005 in Sweden. All procedures where indication for acute coronary angiography was SCA were scrutinized for patient’s characteristics, coronary anatomy and primary decision.
Results During this period, 66 905 procedures were performed (27 036 coronary angiographies and 39 869 PCI) in 27 036 patients. We indentified 93 (0.1%) patients (69 men and 24 women) that underwent acute coronary angiography after an episode of SCA. Median age was 65 years (39 – 89). Previous myocardial infarction was found in 17.2% of the patients, 11.8% were diabetic, 17.2 had chronic heart failure and 30.1% had hypertension. Coronary angiography showed no significant stenosis in 27.7% while in 72.3% one or more significant stenoses were found (20.5% one-vessel disease, 22.9% two-vessel disease, 19.3% three-vessel disease and 9.6% left-main stenosis). Acute coronary revascularization was performed in 48.9% pts (39.1% ad hoc PCI and 9.8% acute CABG). In 51.1% no additional invasive treatment was undertaken. Survival rate at 30 days was 75%.
Conclusion Acute coronary angiography is performed only in a selected fraction of hospitalized patients after sudden cardiac arrest in Sweden. Future studies are necessary to determine whether more aggressive approach with early angiography and invasive interventions may improve survival and long-term prognosis in patients with SCA.