Timing and Outcomes After Coronary Angiography Following Out-of-Hospital Cardiac Arrest Without Signs of ST-Segment Elevation Myocardial Infarction.

Autor: Helber AR; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Helfer DR; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Ferko AR; Department of Emergency Medicine, Reading Hospital, Reading, Pennsylvania., Klein DD; Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania., Elchediak D; Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania., Deaner TS; Department of Emergency Medicine, Reading Hospital, Reading, Pennsylvania., Slagle D; Department of Emergency Medicine, ChristianaCare, Newark, Delaware., White WB; Department of Pulmonary and Critical Care, Maine Medical Center, Portland, Maine., Buckler DG; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York., Mitchell OJL; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Fiorilli PN; Department of Medicine, Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania., Isenberg DL; Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania., Nomura JT; Department of Emergency Medicine, ChristianaCare, Newark, Delaware., Murphy KA; Department of Emergency Medicine, ChristianaCare, Newark, Delaware., Sigal A; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Emergency Medicine, Reading Hospital, Reading, Pennsylvania., Saif H; Lehigh Valley Heart and Vascular Institute, Allentown, Pennsylvania., Reihart MJ; Department of Emergency Services, Penn State Health, Lancaster Medical Center, Lancaster, Pennsylvania., Vernon TM; Penn Medicine Lancaster General Hospital, Lancaster, Pennsylvania., Abella BS; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Jazyk: angličtina
Zdroj: The Journal of emergency medicine [J Emerg Med] 2023 Apr; Vol. 64 (4), pp. 439-447. Date of Electronic Publication: 2023 Mar 28.
DOI: 10.1016/j.jemermed.2023.01.006
Abstrakt: Background: There is broad consensus that resuscitated out-of-hospital cardiac arrest (OHCA) patients with ST-segment elevation myocardial infarction (STEMI) should receive immediate coronary angiography (CAG); however, factors that guide patient selection and optimal timing of CAG for post-arrest patients without evidence of STEMI remain incompletely described.
Objective: We sought to describe the timing of post-arrest CAG in actual practice, patient characteristics associated with decision to perform immediate vs. delayed CAG, and patient outcomes after CAG.
Methods: We conducted a retrospective cohort study at seven U.S. academic hospitals. Resuscitated adult patients with OHCA were included if they presented between January 1, 2015 and December 31, 2019 and received CAG during hospitalization. Emergency medical services run sheets and hospital records were analyzed. Patients without evidence of STEMI were grouped and compared based on time from arrival to CAG performance into "early" (≤ 6 h) and "delayed" (> 6 h).
Results: Two hundred twenty-one patients were included. Median time to CAG was 18.6 h (interquartile range [IQR] 1.5-94.6 h). Early catheterization was performed on 94 patients (42.5%) and delayed catheterization was performed on 127 patients (57.5%). Patients in the early group were older (61 years [IQR 55-70 years] vs. 57 years [IQR 47-65] years) and more likely to be male (79.8% vs. 59.8%). Those in the early group were more likely to have clinically significant lesions (58.5% vs. 39.4%) and receive revascularization (41.5% vs. 19.7%). Patients were more likely to die in the early group (47.9% vs. 33.1%). Among survivors, there was no significant difference in neurologic recovery at discharge.
Conclusions: OHCA patients without evidence of STEMI who received early CAG were older and more likely to be male. This group was more likely to have intervenable lesions and receive revascularization.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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