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Should We Perform an Immediate Coronary Angiogram in All Patients After Cardiac Arrest?

2018; Elsevier BV; Volume: 11; Issue: 3 Linguagem: Inglês

10.1016/j.jcin.2017.09.011

1936-8798

Wulfran Bougouin, Florence Dumas, Nicole Karam, Carole Maupain, Éloi Marijon, Lionel Lamhaut, Daniel Jost, Guillaume Géri, Frankie Beganton, Olivier Varenne, Christian Spaulding, Xavier Jouven, Alain Cariou, Frédéric Adnet, Jean‐Marc Agostinucci, N. Aissaoui-Balanant, Juliette Albuisson, Vincent Algalarrondo, François Alla, Djillali Annane, C. Antoine, P Aubry, Élie Azoulay, Frankie Beganton, D. Benhamou, Wulfran Bougouin, Cédric Bruel, Alain Cariou, Pierre Carli, Charles Cerf, A. Chaïb, J. Chastre, Yves Cohen, Alain Combes, C. Cornaglia, D. da Silva, Vijay Kumar Das, Alexandre Demoule, Nicolas Deye, G. Dhonneur, Jean‐Luc Diehl, S. Dinanian, Leszek Domański, Didier Dreyfuss, D Duboc, J.-L. Dubois-Randé, Olivier Dubourg, F.-X. Duchateau, Florence Dumas, J.P. Empana, Fabrice Extramiana, J.-Y. Fagon, Muriel Fartoukh, Charlotte Fenioux, Fabienne Fieux, F Fraisse, Marco Gabbas, Estelle Gandjbakhch, Bertrand Guidet, P. Henry, F. Hidden Lucet, P. Jabre, Line Jacob, Lee Joseph, Daniel Jost, Didier Journois, Xavier Jouven, Nicole Karam, H. Kassim, Khadija Lahlou‐Laforêt, Lionel Lamhaut, A. Lanceleur, Olivier Langeron, Vincent Lanoë, Éric Lecarpentier, Antoine Leenhardt, Nicolas Lellouche, Virginie Lemiale, F. Linval, Thomas Loeb, Bertrand Ludes, Alice Maltret, Nadia Mansouri, Jean Mantz, Éloi Marijon, J. Marty, Éric Maury, Virginie Maxime, Armand Mekontso-Dessaps, Jean Paul Mira, Xavier Monnet, M C Perier, Olivier Piot, R. Pirraccchio, Isabelle Plu, Mathieu Raux, François Revaux, J.-D. Ricard, Christian Richard, Bruno Riou, France Roussin, F. Santoli, Frédérique Schortgen, Tarek Sharshar, Georgios Sidéris, Christian Spaulding, Jean–Louis Teboul, J-F. Timsit, J.-P. Tourtier, Philippe Tuppin, C. Ursat, Olivier Varenne, Antoine Vieillard‐Baron, Sébastian Voicu, Karim Wahbi,

Trauma and Emergency Care Studies

This study sought to assess the relationship between an immediate invasive strategy and survival after an out-of-hospital cardiac arrest (OHCA) of presumed cardiac cause, according to prognosis evaluated on hospital arrival.An immediate coronary angiogram (CAG) may be associated with better outcome after OHCA in neurologically preserved patients but could be futile in other cases.From May 2011 to May 2015, we collected data for all patients admitted in hospital after OHCA in Paris and its suburbs (France). Risk of in-hospital death was retrospectively calculated using the validated Cardiac Arrest Hospital Prognosis score, which includes age, setting, initial rhythm, durations from collapse to basic life support and from basic life support to return of spontaneous circulation, pH, and epinephrine dose. Independent predictors of survival at discharge (including immediate CAG) were assessed in multivariate logistic regression in each of the 3 pre-defined subgroups of Cardiac Arrest Hospital Prognosis score: low risk ( 200 points) for in-hospital death.A total of 1,410 patients were included and overall survival rate at hospital discharge was 32%. Distribution in the low-, medium-, and high-risk Cardiac Arrest Hospital Prognosis subgroups was 667 (47%), 469 (33%), and 274 patients (20%), respectively. The rate of early CAG was 86%, 66%, and 47% in the low-, medium-, and high-risk subgroups, respectively (p < 0.001). Early invasive strategy was independently associated with better survival in low-risk patients (odds ratio: 2.3; 95% confidence interval: 1.4 to 3.9; p = 0.001), but not in medium-risk (p = 0.55) and high-risk (p = 0.43) patients. Sensitivity analysis found consistent results.In cardiac arrest patients, our results suggest that investigations regarding early CAG after OHCA should focus on patients with preserved neurological status.