Abstract 9995: Emergency Percutaneous Coronary Intervention in Survivors of Out-of-hospital Cardiac Arrests is Safe and Feasible With Good Outcomes
Purpose: Out-of hospital cardiac arrest (OHCA) is associated with high degrees of morbidity and mortality. We aimed to evaluate the prevalence of coronary disease in survivors of OHCA in our local population, and to assess whether early angiography had an impact on survival.
Methods: Patients with OHCA over a 3-year period were included (January 2012- December 2014). A review of patient records was performed including details of coronary angiogram and PCI findings. Univariate analysis was performed.
Results: There were 45 patients included (71% Males, Mean Age 65.1 ± 12.7 Years). Cardiopulmonary resuscitation (CPR) was started immediately in 62% of patients, and mean time for return of spontaneous circulation was 22.9±18.7 minutes. Ventricular Fibrillation was the initial rhythm identified (80%), followed by PEA (15.5%) and Asystole (4.5%). Post arrest ECG revealed ST-Elevation in 53% (n=24). Patients were grouped into those with and without ST elevation (24 vs.21). All patients had been ventilated prior to angiography, and 46.6% (n=21) were in cardiogenic shock. Coronary angiography revealed at least one significant coronary artery lesion (≥50%) in 91% of patients (n=41), of which 63% (n=26) were due to an acute occlusion. In the STEMI group, 83.3% (n=20) of patients had a significant acute occlusion. In the non-STEMI group, 33.3% (n=7) of patients had a significant lesion, all but one due to an acute occlusion. 11.5% (n=3) of patients with an acute occlusion had no ST changes on their ECG. 41 patients underwent successful PCI.
21 patients (47%) survived to hospital discharge and were also alive at 30-days. STEMI vs. non-STEMI survival (9 vs.12, p = 0.24). The positive and negative predictive value of ST-Elevation on the ECG to determine significant coronary lesions was 83.3% and 71.4% respectively.
Conclusion: Early angiography is feasible and significant coronary artery disease is present in the majority of survivors of OHCA. Occlusive coronary disease is commonly found despite no evidence of ST- Elevation on the ECG.
Author Disclosures: M.O. Mohamed: None. S. George: None. P.A. Calvert: None. P.F. Ludman: None. S.N. Doshi: None. J.N. Townend: None. S.Q. Khan: None.
- © 2015 by American Heart Association, Inc.