Immediate versus early coronary angiography with targeted temperature management in out-of-hospital cardiac arrest survivors without ST-segment elevation: A propensity score-matched analysis from a multicenter registry
- Authors
- Kim, Youn-Jung; Kim, Yong Hwan; Lee, Byung Kook; Park, Yoo Seok; Sim, Min Seob; Kim, Su Jin; Oh, Sang Hoon; Lee, Dong Hoon; Kim, Won Young
- Issue Date
- Feb-2019
- Publisher
- ELSEVIER IRELAND LTD
- Keywords
- Out-of-hospital cardiac arrest; Cardiopulmonary resuscitation; Coronary angiography; Percutaneous coronary intervention; Outcome
- Citation
- RESUSCITATION, v.135, pp 30 - 36
- Pages
- 7
- Journal Title
- RESUSCITATION
- Volume
- 135
- Start Page
- 30
- End Page
- 36
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/18283
- DOI
- 10.1016/j.resuscitation.2018.12.011
- ISSN
- 0300-9572
1873-1570
- Abstract
- Aim: The optimal coronary angiography (CAG) timing in out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE) for good neurologic outcome remains unknown. This study aimed to evaluate whether immediate versus early CAG impacts neurological outcomes of OHCA survivors without STE. Methods: This multicenter retrospective observational registry-based study was conducted at the emergency department (ED) of 8 Korean tertiary care hospitals. Data of adult non-traumatic OHCA patients with no obvious extra-cardiac cause, without STE, who were treated with targeted temperature management (TTM), and in whom CAG was performed within 24 h after return of spontaneous circulation between 2010 and 2015 were extracted. Patients in the immediate (<= 2 h) and early (2-24 h) CAG groups were propensity score matched. The primary endpoint was 1-month good neurological outcomes. Results: Among 346 patients with TTM and CAG, 119 who underwent CAG after 24 h were excluded, leaving 112 and 115 in the immediate and early CAG groups, respectively. Median time to CAG was 120.0 (70.0-224.0) minutes; 97 (42.7%) patients had significant coronary artery stenosis. Good neurological outcome was higher in the early versus immediate CAG group (50.4% vs. 31.3%, P = 0.003), but no significant intergroup difference persisted after matching. CAG timing was not associated with good neurological outcomes (odds ratio, 1.917; 95% confidence interval, 0.954-3.852; P = 0.07). Conclusions: Coronary artery stenosis was found in 42.7% of TTM-treated non-STE OHCA patients with CAG within 24 h, but there was no clear neurological benefit of immediate versus early CAG.
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