Immediate versus early coronary angiography with targeted temperature management in out-of-hospital cardiac arrest survivors without ST-segment elevation: A propensity score-matched analysis from a multicenter registry

Youn Jung Kim, Yong Hwan Kim, Byung Kook Lee, Yoo Seok Park, Min Seob Sim, Su Jin Kim, Sang Hoon Oh, Dong Hoon Lee, Won Young Kim

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    24 Citations (Scopus)

    Abstract

    Aim: The optimal coronary angiography (CAG) timing in out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE) for good neurologic outcome remains unknown. This study aimed to evaluate whether immediate versus early CAG impacts neurological outcomes of OHCA survivors without STE. Methods: This multicenter retrospective observational registry-based study was conducted at the emergency department (ED) of 8 Korean tertiary care hospitals. Data of adult non-traumatic OHCA patients with no obvious extra-cardiac cause, without STE, who were treated with targeted temperature management (TTM), and in whom CAG was performed within 24 h after return of spontaneous circulation between 2010 and 2015 were extracted. Patients in the immediate (≤2 h) and early (2–24 h) CAG groups were propensity score matched. The primary endpoint was 1-month good neurological outcomes. Results: Among 346 patients with TTM and CAG, 119 who underwent CAG after 24 h were excluded, leaving 112 and 115 in the immediate and early CAG groups, respectively. Median time to CAG was 120.0 (70.0–224.0) minutes; 97 (42.7%) patients had significant coronary artery stenosis. Good neurological outcome was higher in the early versus immediate CAG group (50.4% vs. 31.3%, P = 0.003), but no significant intergroup difference persisted after matching. CAG timing was not associated with good neurological outcomes (odds ratio, 1.917; 95% confidence interval, 0.954–3.852; P = 0.07). Conclusions: Coronary artery stenosis was found in 42.7% of TTM-treated non-STE OHCA patients with CAG within 24 h, but there was no clear neurological benefit of immediate versus early CAG.

    Original languageEnglish
    Pages (from-to)30-36
    Number of pages7
    JournalResuscitation
    Volume135
    DOIs
    Publication statusPublished - 2019 Feb

    Bibliographical note

    Publisher Copyright:
    © 2018 Elsevier B.V.

    Keywords

    • Cardiopulmonary resuscitation
    • Coronary angiography
    • Out-of-hospital cardiac arrest
    • Outcome
    • Percutaneous coronary intervention

    ASJC Scopus subject areas

    • Emergency Medicine
    • Emergency
    • Cardiology and Cardiovascular Medicine

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