Performance of coronary angiography and intervention after out of hospital cardiac arrest

Aims: Out of Hospital Cardiac Arrest (OHCA) is frequently attributed to coronary artery disease, thus guidelines recommend coronary angiography (CAG) for survivors of OHCA. However, the real-world application of these guidelines is unknown, and we sought to evaluate CAG practices in the contemporary OHCA population.

Methods: The Clinical Outcomes Assessment Program (COAP), a Washington State public reporting system, and the Cardiac Arrest Registry to Enhance Survival (CARES), a national registry of OHCA, were matched to characterize OHCA presentations between 2014 and 2015. Adults presenting to PCI-capable centers after OHCA were included. Logistic regression analyses were performed to assess predictors of undergoing CAG after OHCA.

Results: 2361 subjects were included with 729 (31%) proceeding to CAG, and 354 (15%) receiving PCI. The majority had return of spontaneous circulation (ROSC) at hospital arrival without identified ST elevations (72.2%). Of those with ST elevations and ROSC, 69% underwent CAG. OHCAs without ST elevations underwent CAG in 29.6% and PCI in 12.6%. After adjustment, older patients (aOR 0.73, 95% CI 0.72-0.84 per decade) and women (aOR 0.53, 95% CI 0.41-0.67) were less likely to proceed to CAG. Patients with witnessed arrest (aOR 2.07, 95% CI 1.62-2.67), VT/VF (aOR 6.11, 95% CI 4.85-7.69), ST elevations (aOR 3.82, 95% CI 2.71-5.38) and sustained ROSC (aOR 3.64, 95% CI 2.62-5.04) were more likely to undergo CAG.

Conclusion: Only one-third of patients presenting to PCI-capable hospitals underwent CAG after OHCA. Patient selection for an invasive strategy after OHCA appeared to be heavily influenced by pre-hospital presentation variables.