PCI in Post–Cardiac Arrest Patients Without ST Elevation
What is the impact of early invasive therapy in patients presenting with out-of-hospital cardiac arrest (OHCA) without ST-segment elevation (STE)?
The authors reported their experience with an early invasive approach to the management of patients presenting with cardiac arrest and enrolled in the PROCAT (Parisian Registry Out-of-Hospital Cardiac Arrest) II registry.
During the study period (2004-2013), 958 patients with OHCA underwent emergent coronary angiography. Of these, 695 (73%) had no evidence of STE on the post-resuscitation electrocardiography. A percutaneous coronary intervention (PCI) was performed in 199 of 695 (29%) patients. A favorable neurological outcome was observed in 43% of patients who underwent PCI compared with 33% of those who did not (adjusted odds ratio [OR], 1.80; 95% confidence interval [CI], 1.09-2.97; p = 0.02). Other independent predictors of favorable outcome were a resuscitation duration of <20 minutes, an initial shockable rhythm, and a lower dose of epinephrine during resuscitation. An initial shockable rhythm (OR, 2.83; 95% CI, 1.84-4.36; p < 0.001) was the only independent indicator for PCI requirement.
Nearly one-third of patients with OHCA and no STE had coronary artery disease requiring PCI. PCI was associated with a better outcome in this cohort.
This study adds to the growing data demonstrating the presence of significant coronary artery disease in a large proportion of patients with OHCA even in the absence of STEs. Further, the patients who underwent PCI have generally have had a better outcome. While randomized data are urgently needed to clarify the true utility of PCI in this setting, these data make a strong argument to consider an invasive approach in all OHCA patients with a shockable rhythm.
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