Coronary angiography following cardiac arrest improves survival

Performing immediate coronary angiography following cardiac arrest led to improvements in survival among patients with and without STEMI, according to a retrospective registry analysis.

Karl B. Kern, MD, of the Sarver Heart Center at the University of Arizona in Tucson, and colleagues published their findings online in the Journal of the American College of Cardiology: Cardiovascular Interventions on June 24.

“Early coronary angiography provides useful information and can direct therapy, particularly identifying those who may benefit from acute coronary reperfusion therapy in those without STEMI as well as those with STEMI,” they wrote.

They noted that approaches such as cardiocerebral resuscitation with chest compression–only cardiopulmonary resuscitation have led to improved survival after cardiac arrest. When patients are resuscitated, targeted temperature management (TTM) and coronary artery reperfusion have proven effective in surviving at hospital discharge, as well. Kern et al wrote that TTM involves cooling to a core temperature of 33 to 36 degrees Celsius for 12 to 24 hours.

Recent guidelines from the American College of Cardiology and European Society of Cardiology recommend starting TTM early in comatose patients with STEMI and out-of-hospital cardiac arrest, according to Kern et al. They also suggest performing immediate angiography in resuscitated out-of-hospital cardiac arrest patients with STEMI.

In this study, the researchers analyzed data on 745 comatose patients in the INTCAR (International Cardiac Arrest) registry who survived to hospital admission after cardiac arrest from February 2006 to May 2011. The registry includes descriptions of post-resuscitation cardiac arrest care at 34 centers in the U.S. and Europe.

Of the patients, 68 percent were men, 58 percent had ventricular fibrillation cardiac arrest, 98 percent received therapeutic hypothermia and 79 percent had out-of-hospital cardiac arrest. Further, 198 patients had STEMI and 548 did not have STEMI, while 96.9 percent of patients with STEMI underwent coronary angiography compared with 45.1 percent of patients who did not have STEMI.

The researchers found 55.1 percent of patients in the STEMI group and 41.3 percent of patients in the non-STEMI group survived to hospital discharge, although the survival rates were similar for patients undergoing immediate coronary angiography whether they had STEMI (54.7 percent) or did not have STEMI (57.9 percent).

The study did not include resuscitated cardiac arrest patients who were responsive or awake at the hospital, which the researchers wrote could be a limitation. Another potential limitation was that physicians had the discretion when and if they would perform coronary angiography.