Abstract 74: The Survival Benefit of Coronary Angiography After Cardiac Arrest Is Observed Only in Patients with Shockable Rhythms
BACKGROUND: The identification and treatment of a reversible cause of arrest is considered an important step in post arrest care. Observational data suggests a survival benefit is derived from the performance of coronary angiography in post cardiac arrest patients who survive to hospital admission. We hypothesized that the benefit of this therapy would be diminished in victims who presented with non-shockable rhythms.
METHODS: We analyzed a prospectively-collected registry of all cardiac arrests in the state of Utah between July 1, 2012 through December 31, 2013. We compared outcomes of patients surviving to hospital admission, stratified by presenting rhythm and performance of angiography. Logistic regression was used to control for confounders.
RESULTS: During the study period, 464/1,534 (30.2%) out-of-hospital cardiac arrest victims survived to hospital admission. Coronary angiography was performed in 133 (28.7%). Neurologically-intact survival was higher in patients with shockable rhythms who underwent angiography compared with those who didn’t (73% vs 32%, p<0.0001, TABLE). However, this survival benefit was not apparent in patients with a presenting rhythm of asystole or pulseless electrical activity (17% vs 20%, p=0.7). When stratified by presenting rhythm and controlling for age, witnessed arrest, bystander CPR, and gender, only victims with an initial shockable rhythm demonstrated increased odds of neurologically-intact survival (OR 5.9, 95% CI 2.9-11.7, p<0.0001)
CONCLUSIONS: Our analysis suggests that post arrest angiography, on average, provides a survival advantage only among victims with an initial shockable rhythm. However, this data is observational and prone to selection bias and residual confounding.
Author Disclosures: R.J. Preston: None. C. Stratford: None. P. Taillac: None. S. Youngquist: Speakers Bureau; Modest; Physio-Control. Consultant/Advisory Board; Modest; Keytechnic.
- © 2014 by American Heart Association, Inc.