Abstract 14830: Early Coronary Angiography Is Associated With Improved 30-day Survival in Out-of-hospital Cardiac Arrest Patients Without ST-elevation on First Ecg
Background and Aim: Observational studies have shown high rates of acute coronary occlusions in OHCA patients despite the absence of ST -elevation on ECG. Current guidelines emphasize the need for urgent coronary angiography (CAG) after an OHCA. However, there is a lack of evidence for this strategy and data from previous observational studies is conflicting regarding the benefit of early CAG in these patients.
The aim of this registry-based study was to investigate whether early CAG after OHCA is associated with improved 30-day survival in patients without ST-elevation on ECG after return of spontaneous circulation.
Methods: An observational study based on prospectively collected data from the Swedish cardiac arrest and the SWEDEHEART registries during 2008-2013. Patients included were those with bystander witnessed OHCAs, age 18 to 80 years, ventricular fibrillation as first rhythm, admitted alive at hospital, unconscious (i.e. Glasgow Coma scale ≤ 8). Patients with ST-elevation or presumed new left bundle branch block on first ECG were excluded.
Patients were divided into two groups; early CAG (within 24 hours after admission) versus late or no CAG. Primary endpoint was 30-day survival. The logistic regression analysis included gender, age, bystander CPR, location of the arrest (i.e. home vs outside home) and presumed cardiac cause.
Results: In total, 885 OHCA cases with ventricular fibrillation as first rhythm and ECG without ST-elevation were included in this survey. Among them, 229 patients (26%) received early CAG and 656 (74%) late or no CA. The 30-day survival rate was 66,8% in patients receiving early CAG versus 49,4% with late or no CAG. In the multivariate analysis the adjusted odds ratio for 30-day survival was OR 1,95 in the group that received early CAG (95% CI 1,33-2,85 p<0,001).
Conclusions: In this population with witnessed OHCA, ventricular fibrillation as first rhythm and ECG without ST-elevation, early coronary angiography performed within 24 hours was associated with improved 30-day survival. There is an urgent need for randomized trials to confirm this finding. A Swedish national randomized controlled trial was started during 2015 to address this issue (Clinicaltrial id: NCT02309151).
Author Disclosures: L. Elfwén: None. R. Lagedal: None. M. Jonsson: None. J. Hollenberg: None. U. Jensen: None. M. Ringh: None. L. Svensson: None. S. Rubertsson: None. S. James: None. P. Nordberg: None.
- © 2016 by American Heart Association, Inc.