People who received percutaneous coronary intervention early after non-trauma, out-of-hospital cardiac arrest lived significantly longer than those who didn’t, in a French study presented Saturday at the ReSuscitation Science Symposium.
“Our work suggests that the systematic use of PCI in all cardiac arrest patients admitted in the intensive care unit or emergency department has a beneficial impact on long-term prognosis,” said Guillaume Geri, MD, assistant professor at Hospital Cochin in Paris, France.
Geri and his colleagues prospectively studied 1,722 non-trauma, out-of-hospital cardiac arrest patients admitted to a Parisian cardiac trauma center after successful resuscitation from 2000-13. The patients’ median age was 60, and 71.5 percent were male.
Of the participants, 32.3 percent experienced out-of-hospital cardiac arrest in public. Of these, 86.7 percent were witnessed and a shockable rhythm was reported for 54.6 percent.
Seventy-one percent received therapeutic hypothermia and 27.8 percent received PCI.
Comparing PCI vs non-PCI patients:
- After 30 days, the patients who did not receive PCI had a 26 percent survival rate compared to a 42 percent survival rate for those patients who did receive PCI.
- Three-year survival rates were 19 percent for non-PCI patients and 37 percent for PCI recipients.
- Ten-year survival rates were 13 percent for non-PCI patients and 32 percent for PCI recipients.
In a multivariate analysis, Geri and colleagues considered factors such as age, gender, initial rhythm, TH and PCI.
PCI is typically mandated for OHCA patients who have a ST-segment elevation myocardial infarction. There is considerable debate on whether systematic coronary angiogram after cardiac arrest is necessary in non-STEMI, OHCA patients.
“Our study shows the benefit of immediate PCI on short- and long-term outcomes after cardiac arrest without an obvious extra-cardiac cause, such as trauma or hemorrhagic shock,” Geri said. “The main issue is to correctly select cardiac arrest patients for the cath lab.”
Prehospital data from several published studies haven’t ruled out coronary occlusion as the cause of OHCA. So Geri and his colleagues encourage systematic and immediate coronary angiogram to be performed in all non-trauma, OHCA patients, with PCI performed when appropriate in those without an obvious extra-cardiac cause after successful resuscitation.
“We hope that our findings will encourage physicians to consider early coronary angiogram and PCI, if necessary, in OHCA patients,” Geri said.