Coronary angiography, PCI may benefit out-of-hospital cardiac arrest survivors

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 - Tim Casey
Tim Casey, Executive Editor

Recently, more people have undergone coronary angiography and PCI after they were resuscitated following out-of-hospital cardiac arrest. Despite the positive outcomes associated with the procedures, more trials are needed to determine whether they improve survival, according to the authors of a study published last month.

The results, which appeared online Sept. 14 in JAMA Cardiology, showed that the use of coronary angiography increased from 27.2 percent to 43.9 percent from 2000 to 2012. During that same time period, the use of PCI increased from 9.5 percent to 24.1 percent. More patients survived in later years, as well.

Lead researcher Nish Patel, MD, of the University of Miami Miller School of Medicine, and colleagues analyzed the Nationwide Inpatient Sample database and identified 407,974 patients hospitalized after ventricular tachycardia or pulseless ventricular fibrillation (VT/VF) out-of-hospital cardiac arrest.

They mentioned that the increased use of coronary angiography and PCI coincided with recommendations from major medical societies. For instance, the American College of Cardiology, American Heart Association (AHA) and European Society of Cardiology in 2006 published guidelines suggesting the use of coronary angiography in patients with life-threatening arrhythmias or survivors of sudden cardiac death with an intermediate to high probability of coronary artery disease.

The latest AHA guidelines, published last year, recommend coronary angiography in patients with out-of-hospital cardiac arrest with ST-segment elevation (STE) and patients without STE but who have suspected cardiac origin as the cause of cardiac arrest.

Still, fewer than half of patients in this real-world study had coronary angiography or PCI. The researchers noted that some centers only perform coronary angiography on certain out-of-hospital cardiac arrest survivors and excluded the highest-risk patients.

“This position is based on the requirement for public reporting of mortality and complication rates and its effect on the reputation and possibly the compensation in large interventional programs,” they wrote.

Although studies have shown improved outcomes with the use of coronary angiography, the researchers mentioned all the trials have been retrospective, so the survival rate increase could be due to selection bias.

“A large, multicenter randomized clinical trial is still needed to definitively prove that early coronary angiography after [out-of-hospital cardiac arrest] is truly beneficial,” the researchers wrote.