Among patients presenting with both out-of-hospital cardiac arrest (OHCA) and STEMI, substantial hospital-level variation was found in providing immediate coronary angiography (CA), according to a Brief Report published Feb. 11 in JACC.

Ahmed Elkaryoni, MD, FACC, et al., included 14,533 adult patients from 673 hospitals captured by the ACC’s Chest Pain – MI Registry, who presented with STEMI complicated by OHCA. The primary outcome was immediate CA, occurring within two hours of hospital arrival.

Overall, 12,618 (86.8%) patients underwent immediate CA, 1,915 underwent delayed CA and 906 had no CA. There was substantial variation among hospitals, with rates of immediate CA ranging from 0% to 100%. Notably, 25% of hospitals had an immediate CA rate of 100%, showing this rate is achievable. When looking at two randomly chosen sites, odds of immediate CA varied by 81%.

The authors identified several predictors of immediate CA, including “younger age, male sex, White race, private insurance, no cardiogenic shock on hospital arrival, [and] witnessed arrest.” They also observed an association between immediate CA and arrival time between 6 a.m. and 5:59 p.m.

“Strategies to standardize the approach for this high-risk patient group is needed,” they write. “Our finding that patients who arrived outside of daytime working hours were less likely to be treated with immediate CA illustrates a potentially modifiable factor that could be addressed with better standardization of local and regional care protoco