Association of emergent and elective percutaneous coronary intervention with neurological outcome and survival after out-of-hospital cardiac arrest in patients with and without a history of heart disease

作者：Kim Min Jung; Ro Young Sun^*; Shin Sang Do; Song Kyoung Jun; Ahn Ki Ok; Hong Sung Ok; Kim Young Taek

来源：Resuscitation, 2015, 97: 115-121.

DOI：10.1016/j.resuscitation.2015.08.019

• Out-of-hospital cardiac arrest
• Percutaneous coronary intervention
• Heart diseases

Background: It is unclear whether the benefits of post-resuscitative percutaneous coronary intervention (PCI) are equally observed across out-of-hospital cardiac arrests (OHCAs) with different clinical presentations. The purpose of this study was to assess the effect of PCI in outcomes of OHCA and to compare patient prognosis by history of heart disease (HD) and presentations of nonshockable vs. shockable arrest rhythm by electrocardiogram (ECG).
Methods: A population-based observational study was conducted on OHCAs of cardiac etiology in Korea who survived to admission between 2009 and 2013. Multivariable logistic regression analyses were conducted to assess the associations between PCI and outcomes (favorable neurological outcome and survival-to-discharge) and to test the interaction effects of PCI with history of HD and with presence of shockable rhythm.
Results: A total of 9762 OHCAs were analyzed. PCI was done in 1140 (11.7%), and neurological recovery were observed in 45.7% of the PCI group and 13.3% of the untreated group. Effects of PCI on neurological recovery were observed similarly in patients with and without history of HD (OR = 2.33 (1.62-3.35) and OR = 2.37 (1.95-2.89), respectively). PCI was associated with survival-to-discharge only in patients without history of HD (OR = 1.80 (1.51-2.15)). PCI was associated with neurological recovery and survival-to-discharge in both shockable and nonshockable rhythms, although the estimates were relatively higher in those with nonshockable rhythms (OR for neurological recovery = 2.60 (2.04-3.32); and OR for survival = 1.78 (1.46-2.17)).
Conclusions: This study corroborates that PCI is an advantageous treatment option for all patients with OHCA regardless of established diagnosis with HD and presentations of shockable rhythm.

• 出版日期2015-12