Abstract 2464: Should We Perform an Immediate Coronary Angiogram in All Survivors of Out-of Hospital Cardiac Arrest With No Obvious Extra-Cardiac Cause?
Background: The overall survival of patients sustaining an Out-of Hospital Cardiac Arrest (OHCA) is extremely poor. Knowledge of the early predictive factors at admission could help to determine the best strategy to improve the prognosis of these patients. The aim of our study was to determine early parameters related to in-hospital mortality of patients sustaining an OHCA.
Methods: Between January 2003 and December 2008, 435 survivors of OHCA were referred to a French tertiary center in Paris and prospectively included in the study. An immediate coronary angiogram and a PerCutaneous Intervention (PCI), when required, were systematically performed in all patients if there was no obvious non-cardiac cause of arrest. The prognostic value of pre-hospital and in-hospital characteristics on in-hospital mortality was evaluated using logistic regression analysis.
Results: All the 435 patients admitted alive to hospital during this period had an immediate coronary angiogram and 173 (39.8%) had a successful PCI; 264 patients (60.7%) died during their hospital stay. Mean (SD) ICU length-of-stay was 6.27 days (5.37). Independent predictors of death were an older age (OR=1.05; [1.03–1.07]), a longer interval (>5minutes) between collapse and Base Life Support (OR=3.32;[1.91–5.78]), a longer interval (>15 minutes) between Base Life Support and Return Of Spontaneous Circulation (OR=3.60;[2.14–6.07]) and greater blood lactate (mmol.L−1) at hospital admission (OR for each quintile increase =2.07 [1.65–2.61]p for trend=0.001). VF/VT as the initial rhythm (OR=0.55 [0.32–0.96]) and a successful PCI (OR=0.40 [0.24–0.67]) were associated with lower mortality risk.
Conclusions: The high in-hospital mortality rate in survivors of OHCA without obvious extra-cardiac cause is related to initial factors, especially the delays of resuscitation. On the opposite, our results suggest that a successful immediate PCI is strongly and independently associated with greater survival.