Abstract 11: Early Cardiac Catheterization Is Associated with Improved Survival in Comatose Survivors of Cardiac Arrest Without ST-Segment Elevation Myocardial Infarction
Background: Early cardiac catheterization (CC) is generally accepted in the standard of care in patients with cardiac arrest due to STEMI. The optimum timing of CC following cardiac arrest without STEMI is unknown.
Methods: Retrospective analysis was performed on 150 consecutive comatose survivors of cardiac arrest treated with therapeutic hypothermia (TH). Patients with STEMI and patients without a shockable initial rhythm were excluded. Early CC was defined as CC within 24 hours of admission (during treatment with TH). Multivariable logistic regression was used to examine the effect of early CC on survival with good neurologic outcome at hospital discharge, defined by Cerebral Performance Category.
Results: 53 patients were excluded due to an initial nonshockable rhythm, and 28 patients were excluded due to STEMI. A total of 73 patients with cardiac arrest due to ventricular arrhythmia were analyzed: 53% (39/73) received early CC, and 47% (34/73) either did not receive CC, or received CC greater than 24 hours after admission. Of the patients treated with early CC, 41% (16/39) received percutaneous coronary intervention, compared to 100% (3/3) of those who received late catheterization. The overall in-hospital mortality rate was 47.9%. Survival to hospital discharge with a good neurologic outcome (CPC 1 or 2) was observed in 59% (23/39) of the patients who received early CC, compared to 36% (12/34) of patients who did not. After adjusting for age, comorbid medical conditions, time to return of spontaneous circulation, bystander CPR, and shock, early CC was significantly associated with improved survival to hospital discharge with good neurologic outcome (OR 3.5, 95% CI 1.2-10.4, p=0.02). Acute coronary occlusion was identified in 48% (20/42) of patients who received CC at any time. There was no difference in the time to initiation of TH (median time, 250 versus 300 minutes; p=0.70) or time to reach target temperature (median time, 480 versus 480 minutes; p=0.61) between the groups.
Conclusions: Early CC is associated with improved survival in patients with cardiac arrest due to ventricular arrhythmia without STEMI who are treated with TH. The incidence of coronary occlusion identified in this population is high despite the absence of STEMI.
- © 2012 by American Heart Association, Inc.