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Review of A Large Clinical Series: Coronary Angiography Predicts Improved Outcome Following Cardiac Arrest: Propensity-adjusted Analysis

Department of Emergency Medicine, University of Maryland, Baltimore, Maryland

Clifton W. Callaway, MD, PhD

Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

Samar R. El Khoudary, PhD, MPH

Division of Cardiology Department of Epidemiology (SRE), University of Pittsburgh, Pittsburgh, Pennsylvania, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

Charity G. Moore, PhD, MSPH

Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

René J. Alvarez, MD

Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

Jon C. Rittenberger, MD, MS

Department of Emergency Medicine, University of Maryland, Baltimore, Maryland, rittjc{at}upmc.edu

Objectives: Determine if clinical parameters of resuscitated patients predict coronary angiography (CATH) performance and if receiving CATH after cardiac arrest is associated with outcome. Introduction: CATH is associated with survival in patients suffering out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation or ventricular tachycardia(VF/VT). Its effect on outcome in other cohorts is unknown. Methods: Chart review of resuscitated cardiac arrest patients between 2005 and 2007. Exclusion criteria: immediate withdrawal of care, hemodynamic collapse, or neurologic exam under sedation. Clinical parameters included Glasgow Coma Scale (GCS) arrest location, presenting rhythm, age, and acute ischemic ECG changes (new left bundle branch block or ST-elevation myocardial infarction-STEMI). Logistic regression identified clinical parameters predicting CATH. The association between CATH and good outcome (discharge home or to acute rehabilitation facility) was determined using logistic regression adjusting for likelihood of receiving CATH via propensity score. Result: Of the 241 patients, 96 (40%) received CATH. Significant disease (70% stenosis) of 1 coronary arteries was identified in 69% of patients including 57% of patients without acute ischemic ECG changes. Unadjusted predictors of CATH were sex, method of arrival, OHCA, presenting rhythm, acute ischemic ECG changes, and GCS. Propensity adjusted logistic regression demonstrated an association between CATH and good outcome (OR 2.16; 95% CI 1.12, 4.19; P < 0.02). Conclusion: CATH is more likely to be performed in certain patients and identifies a significant number of high-grade stenoses in this population. Receiving CATH was independently associated with good outcome.

Key Words: heart arrest • resuscitation • catheterization • ventricular fibrillation

This version was published on May 1, 2009

Journal of Intensive Care Medicine, Vol. 24, No. 3, 179-186 (2009)
DOI: 10.1177/0885066609332725


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