Should We Perform an Immediate Coronary Angiogram in All Patients After Cardiac Arrest?: Insights From a Large French Registry

Wulfran Bougouin; Florence Dumas; Nicole Karam; Carole Maupain; Eloi Marijon; Lionel Lamhaut; Daniel Jost; Guillaume Geri; Frankie Beganton; Olivier Varenne; Christian Spaulding; Xavier Jouven; Alain Cariou; Sudden Death Expertise Center

doi:10.1016/j.jcin.2017.09.011

Should We Perform an Immediate Coronary Angiogram in All Patients After Cardiac Arrest?: Insights From a Large French Registry

JACC Cardiovasc Interv. 2018 Feb 12;11(3):249-256. doi: 10.1016/j.jcin.2017.09.011.

Collaborators

Sudden Death Expertise Center:
F Adnet, J M Agostinucci, N Aissaoui-Balanant, J Albuisson, V Algalarrondo, F Alla, D Annane, C Antoine, P Aubry, E Azoulay, F Beganton, D Benhamou, W Bougouin, C Bruel, A Cariou, P Carli, C Cerf, A Chaib, J Chastre, Y Cohen, A Combes, C Cornaglia, D Da Silva, V Das, A Demoule, N Deye, G Dhonneur, J L Diehl, S Dinanian, L Domanski, D Dreyfuss, D Duboc, J L Dubois-Rande, O Dubourg, F X Duchateau, F Dumas, J P Empana, F Extramiana, J Y Fagon, M Fartoukh, C Fenioux, F Fieux, F Fraisse, M Gabbas, E Gandjbakhch, B Guidet, P Henry, F Hidden Lucet, P Jabre, L Jacob, L Joseph, D Jost, D Journois, X Jouven, N Karam, H Kassim, K Lahlou-Laforet, L Lamhaut, A Lanceleur, O Langeron, V Lanoe, E Lecarpentier, A Leenhardt, N Lellouche, V Lemiale, F Linval, T Loeb, B Ludes, A Maltret, N Mansouri, J Mantz, E Marijon, J Marty, E Maury, V Maxime, A Mekontso-Dessaps, J P Mira, X Monnet, M C Perier, O Piot, R Pirraccchio, I Plu, M Raux, F Revaux, J D Ricard, C Richard, B Riou, F Roussin, F Santoli, F Schortgen, T Sharshar, G Sideris, C Spaulding, J L Teboul, J F Timsit, J P Tourtier, P Tuppin, C Ursat, O Varenne, A Vieillard-Baron, S Voicu, K Wahbi

Affiliations

¹ Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Sudden Death Expertise Center, Paris, France.
² Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris, France.
³ Cardiology Department, Pitié-Salpétrière Hospital, APHP, Paris, France.
⁴ Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Rescu at Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
⁵ Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France.
⁶ Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Brigade de Sapeurs Pompiers de Paris, Paris, France.
⁷ Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Center, Paris, France.
⁸ Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France.
⁹ Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Cardiology Department, Cochin Hospital, APHP, Paris, France.
¹⁰ Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France. Electronic address: alain.cariou@cch.aphp.fr.

PMID: 29413238
DOI: 10.1016/j.jcin.2017.09.011

Abstract

Objectives: This study sought to assess the relationship between an immediate invasive strategy and survival after an out-of-hospital cardiac arrest (OHCA) of presumed cardiac cause, according to prognosis evaluated on hospital arrival.

Background: An immediate coronary angiogram (CAG) may be associated with better outcome after OHCA in neurologically preserved patients but could be futile in other cases.

Methods: From May 2011 to May 2015, we collected data for all patients admitted in hospital after OHCA in Paris and its suburbs (France). Risk of in-hospital death was retrospectively calculated using the validated Cardiac Arrest Hospital Prognosis score, which includes age, setting, initial rhythm, durations from collapse to basic life support and from basic life support to return of spontaneous circulation, pH, and epinephrine dose. Independent predictors of survival at discharge (including immediate CAG) were assessed in multivariate logistic regression in each of the 3 pre-defined subgroups of Cardiac Arrest Hospital Prognosis score: low risk (<150 points), medium risk (150 to 200 points), and high risk (>200 points) for in-hospital death.

Results: A total of 1,410 patients were included and overall survival rate at hospital discharge was 32%. Distribution in the low-, medium-, and high-risk Cardiac Arrest Hospital Prognosis subgroups was 667 (47%), 469 (33%), and 274 patients (20%), respectively. The rate of early CAG was 86%, 66%, and 47% in the low-, medium-, and high-risk subgroups, respectively (p < 0.001). Early invasive strategy was independently associated with better survival in low-risk patients (odds ratio: 2.3; 95% confidence interval: 1.4 to 3.9; p = 0.001), but not in medium-risk (p = 0.55) and high-risk (p = 0.43) patients. Sensitivity analysis found consistent results.

Conclusions: In cardiac arrest patients, our results suggest that investigations regarding early CAG after OHCA should focus on patients with preserved neurological status.

Keywords: cardiac arrest; coronary angiogram; percutaneous coronary intervention; prognosis; sudden death.

Publication types

Multicenter Study
Observational Study

MeSH terms

Aged
Clinical Decision-Making
Coronary Angiography*
Female
Hemodynamics
Hospital Mortality
Humans
Male
Middle Aged
Neurologic Examination
Out-of-Hospital Cardiac Arrest / diagnostic imaging*
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / physiopathology
Out-of-Hospital Cardiac Arrest / therapy
Paris
Patient Selection
Predictive Value of Tests
Prognosis
Recovery of Function
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors