Long-term survival of successfully resuscitated comatose out-of-hospital cardiac arrest patients who undergo acute systematic coronary angiogram

Autor: Sebastian Voicu, Frédéric J. Baud, Julien Adjedj, Patrick Henry, N. Magkoutis, Jean-Guillaume Dillinger, Nicolas Deye, Stéphane Manzo-Silberman, G. Sideris, Bruno Mégarbane
Rok vydání: 2013
Předmět:
Zdroj: European Heart Journal. 34:P4038-P4038
ISSN: 1522-9645
0195-668X
DOI: 10.1093/eurheartj/eht309.p4038
Popis: Purpose: Coronary angiogram (CA) with percutaneous coronary intervention (PCI) on admission may improve survival to hospital discharge in patients resuscitated from an out-of-hospital cardiac arrest (OHCA), but data on the long-term survival are rare. The purpose of our study was to assess long-term survival in OHCA patients managed with CA on admission and PCI if indicated and to compare survival between patients with and without acute myocardial infarction (AMI). Methods: Retrospective single-centre study including patients ≥18 years old resuscitated from an OHCA without obvious non-cardiac cause undergoing CA on admission with PCI if indicated. AMI was diagnosed angiographically as presence of lesions suggestive of ruptured plaques with critical stenosis and presence of thrombus easily crossed by an angioplasty wire. Survival was recorded at hospital discharge and at 5-years follow-up and probability of survival was estimated by Kaplan-Meier survival curves. Data are expressed as numbers (percentages) and median (interquartile range-IQR). Results: 300 comatose patients aged 56 (48-67) were included between 2002 and 2011. 130 patients (43%) had ventricular fibrillation, 116 (39%) asystole, 6 (2%) ventricular tachycardia, 18 (6%) pulseless electrical activity and 30 (10%) had unknown initial rhythm. All patients had CA on hospital admission and 93 (31%) had angiographically defined AMI. PCI was attempted in 85 (91%) of the patients with AMI, successful in 79 (93%) of the attempts. Therapeutic hypothermia was performed in 256 (84%) of the patients. Survival at hospital discharge was 32.3% (97 survivors). After hospital discharge, 5-year overall probability of survival was 81.7±5.4%. Probability of survival from admission to 5-year follow-up was 26.2% ± 2.8%. Patients with AMI had better survival at hospital discharge, 40.8% (38 survivors) than non-AMI patients, 28.5% (59 survivors), p=0.047. There was a tendency for better post-discharge probability of survival at 5-years follow-up in AMI patients, 92.2% ± 5.4% versus 73.4±8.6% in non-AMI patients, hazard ratio (HR) = 2.7, confidence interval (CI) = (0.8-8.9), p=0.1. Probability of survival from admission to 5-years follow-up was better for AMI patients, 37.4% ± 5.2% than for non-AMI patients, 20.7% ± 3.0%, HR = 1.5, CI = (1.12-2.0), p=0.0067. Conclusion: We observed a very favourable post-discharge prognosis in OHCA patients undergoing on-admission CA with PCI if indicated. In this study, patients suffering OHCA due to AMI had better survival to hospital discharge and at 5 years follow-up than patients suffering OHCA due to other causes.
Databáze: OpenAIRE
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