After an out-of-hospital cardiac arrest, the use of coronary angiography and PCI increased from 2000 to 2012 among patients with initial rhythms of ventricular tachycardia or pulseless ventricular fibrillation (VT/VF), according to an observational analysis. There was also an improvement in survival to hospital discharge and discharge home.
Still, the majority of patients still did not undergo coronary angiography and revascularization by the end of the study.
Lead researcher Nish Patel, MD, of the University of Miami Miller School of Medicine, and colleagues published their results online in JAMA Cardiology Sept. 14.
Each year, approximately 325,000 people in the U.S. have out-of-hospital cardiac arrest, and only 10 percent survive, according to the researchers. Guidelines from the American Heart Association (AHA) recommend coronary angiography in patients with out-of-hospital cardiac arrest with a suspected cardiac cause and ST-segment elevation (STE). The AHA also suggests physicians consider coronary angiography for patients who present without STE but with a suspected cardiac cause of cardiac arrest.
This analysis included 407,974 patients who were hospitalized after VT/VF out-of-hospital cardiac arrest from 2000 through 2012 and were enrolled in the Nationwide Inpatient Sample (NIS) database. The NIS is part of the Healthcare Cost and Utilization Project and contains the data to approximate a 20 percent stratified sample of U.S. community hospitals.
The mean age was 65.7 years old, while 37.9 percent of patients were female and 74.1 percent were white. In addition, 35.2 percent of patients underwent coronary angiography.
Patients with a history of the following conditions were more likely to undergo coronary angiography: ST-elevation MI, lower Deyo modification of the Charlson Comorbidity Index, obesity and hypertension. Meanwhile, the researchers mentioned that diabetes, history of heart failure, chronic obstructive pulmonary disease, chronic kidney disease, anemia, history of neurologic disorder and coagulopathy were associated with lower use of coronary angiography.
From 2000 to 2012, the use of coronary angiography increased from 27.2 percent to 43.9 percent, while the use of PCI increased from 9.5 percent to 24.1 percent.
Meanwhile, among patients with STE, the use of coronary angiography after VT/VF out-of-hospital cardiac arrest increased from 53.7 percent to 87.2 percent and the use of PCI increased from 29.7 percent to 77.3 percent. Among patients without STE, the use of coronary angiography increased from 19.3 percent to 33.9 percent and the use of PCI increased from 3.5 percent to 11.8 percent.
For the overall population of patients with VT/VF out-of-hospital cardiac arrest, the survival rate increased from 46.9 percent in 2000 to 60.1 percent in 2012. The survival rate among patients with STE increased from 59.2 percent to 74.3 percent, while the survival rate among patients without STE increased from 43.3 percent to 56.8 percent.
The researchers mentioned the study had a few limitations, including its retrospective, observational design. They also did not include patients who died in the field, during transport to the hospital or when they arrived at an emergency department and did not assess the timing and effect of the extent of revascularization on clinical outcomes.
“Prospective randomized clinical trials are necessary to address the potential value of broader coronary angiography and PCI use as part of postresuscitation care in adults with VT/VF [out-of-hospital cardiac arrest],” the researchers wrote.