Abstract 106: Does Early Post-Cardiac Arrest Illness Severity Affect the Association Between Immediate Cardiac Catheterization and Improved Outcome?
Objectives: Immediate cardiac catheterization (CATH) is recommended for post cardiac arrest patients with STEMI or suspicion for acute cardiac ischemia. However, it is unclear if early CATH is beneficial to all patients, regardless of illness severity. We hypothesized that patients with worse initial illness severity have less benefit from early CATH.
Methods: Retrospective cohort study of adult, atraumatic post-cardiac arrest patients from 2005-2012 at a cardiac arrest center. Primary endpoint was good outcome (discharge to home or acute rehabilitation). We stratified by Pittsburgh Cardiac Arrest Category (PCAC), a validated illness severity score (range I - IV) & examined the subset of patients with Full Outline of UnResponsiveness (FOUR) score ≤1. To minimize survival bias, we compared outcome within strata of patients with immediate CATH vs. delayed/no CATH using chi-square test. Logistic regression assessed the association between early CATH & good outcome.
Results: Of 1,011 patients, 273 (27%) had immediate CATH. Of those, 73% had OHCA, 72% VF/VT, 72% STEMI, 80% ≥1 diseased vessel, 72% culprit lesion, 56% received PCI, & 23% CABG. Another 71 patients had delayed CATH. Stratified outcomes are in Figure 1. No patient receiving any CATH with FOUR ≤1 (0/27) survived to discharge. No patient with STEMI and FOUR ≤1 (0/15) survived to discharge, regardless of CATH. Adjusting for covariates, immediate CATH (OR 1.7; 95% CI 1.1, 2.8; p=0.04) & PCAC (OR 0.5; 95% CI 0.4, 0.6; p<0.01) were associated with good outcome. Interaction immediate CATH*PCAC was not significant.
Conclusions: Patients with immediate CATH had better outcome in all but the worst illness severity stratum.
- © 2013 by American Heart Association, Inc.