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Immediate Percutaneous Coronary Intervention Is Associated With Improved Short- and Long-Term Survival After Out-of-Hospital Cardiac Arrest

2015; Lippincott Williams & Wilkins; Volume: 8; Issue: 10 Linguagem: Inglês

10.1161/circinterventions.114.002303

1941-7632

Guillaume Géri, Florence Dumas, Wulfran Bougouin, Olivier Varenne, Fabrice Daviaud, Frédéric Pène, Lionel Lamhaut, Jean‐Daniel Chiche, Christian Spaulding, Jean‐Paul Mira, Jean‐Philippe Empana, Alain Cariou,

Trauma and Emergency Care Studies

Background— Whether to perform or not an immediate percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest is still debated. We aimed to evaluate the impact of PCI on short- and long-term survival in out-of-hospital cardiac arrest patients admitted after successful resuscitation. Methods and Results— Between 2000 and 2013, all nontrauma out-of-hospital cardiac arrest patients admitted in a Parisian cardiac arrest center after return of spontaneous circulation were prospectively included. The association between immediate PCI and short- and long-term mortality was analyzed using logistic regression and Cox multivariate analysis, respectively. Propensity score-matching method was used to assess the influence of PCI on short- and long-term survival. During the study period, 1722 patients (71.5% male, median age 60 [49.6, 72.2] years) were analyzed: 628 (35.6%) without coronary angiography, 615 (35.7%) with coronary angiography without PCI, and 479 (27.8%) with both. Among these groups, day 30 and year-10 survival rates were 21% and 11.9%, 35% and 29%, 43% and 38%, respectively ( P <0.01 for each). PCI as compared with no coronary angiography was associated with a lower day-30 and long-term mortality (adjOR coro with PCI versus no coro 0.71, 95% confidence interval [0.54, 0.92]; P =0.02 and adjHR coro with PCI versus no coro 0.44, 95% confidence interval [0.27, 0.71]; P <0.01, respectively). PCI remained associated with a lower risk of long-term mortality (adjHR 0.29; 95% confidence interval [0.14, 0.61]; P <0.01) in propensity score-matching analysis. Conclusions— Immediate PCI after out-of-hospital cardiac arrest was associated with significant reduced risk of short- and long-term mortality. These findings should suggest physicians to consider immediate coronary angiography and PCI if indicated in these patients.