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Original Investigation
November 2016

Trends and Outcomes of Coronary Angiography and Percutaneous Coronary Intervention After Out-of-Hospital Cardiac Arrest Associated With Ventricular Fibrillation or Pulseless Ventricular Tachycardia

Author Affiliations
  • 1Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
  • 2Cleveland Clinic Foundation, Cleveland, Ohio
  • 3Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
  • 4Brigham and Woman’s Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
JAMA Cardiol. 2016;1(8):890-899. doi:10.1001/jamacardio.2016.2860
Key Points

Question  What are the rates of use of coronary angiography and percutaneous coronary intervention (PCI) in out-of-hospital cardiac arrest (OHCA) associated with ventricular tachycardia or pulseless ventricular fibrillation (VT/VF)?

Findings  In this study of 407 974 adult patients hospitalized with VT/VF OHCA from 2000 to 2012, the use of coronary angiography and PCI progressively increased in patients with and without ST-segment elevation. An association was found with increased survival to discharge and survival to discharge home in the overall population of patients with VT/VF OHCA regardless of the presence of ST-segment elevation on the initial electrocardiogram.

Meaning  Prospective randomized clinical trials are necessary to address the potential value of broader coronary angiography and PCI use as part of postresuscitation care in adults with VT/VF OHCA.

Abstract

Importance  The 2015 cardiopulmonary resuscitation and emergency cardiovascular care guidelines recommend performing coronary angiography in resuscitated patients after cardiac arrest with or without ST-segment elevation (STE).

Objective  To assess the temporal trends, predictors, and outcomes of performing coronary angiography and percutaneous coronary intervention (PCI) in patients resuscitated after out-of-hospital cardiac arrest (OHCA) with initial rhythms of ventricular tachycardia or pulseless ventricular fibrillation (VT/VF).

Design, Setting, and Participants  An observational analysis of the use of coronary angiography and PCI in 407 974 patients hospitalized after VT/VF OHCA from January 1, 2000, through December 31, 2012, from the Nationwide Inpatient Sample database. Multivariable analysis was used to assess factors associated with coronary angiography and PCI use. Data analysis was performed from December 12, 2015, to January 5, 2016.

Main Outcomes and Measures  Temporal trends of coronary angiography, PCI, and survival to discharge in patients with VT/VF OHCA.

Results  Among the 407 974 patients hospitalized after VT/VF OHCA, 143 688 (35.2%) were selected to undergo coronary angiography. The mean (SD) age of the total population was 65.7 (14.9) years, 37.9% were female, and 74.1% were white, 13.4% black, 6.8% Hispanic, and 5.7% other race. Use of coronary angiography increased from 27.2% in 2000 to 43.9% in 2012 (odds ratio, 2.47; 95% CI, 2.25-2.71; P for trend < .001), and PCI increased from 9.5% in 2000 to 24.1% in 2012 (odds ratio, 4.80; 95% CI, 4.21-5.66; P for trend < .001). From 2000 to 2012, coronary angiography and PCI after VT/VF OHCA increased in patients with STE (53.7% to 87.2%, P for trend < .001, and 29.7% to 77.3%, P for trend < .001, respectively) and those without STE (19.3% to 33.9%, P for trend < .001, and 3.5% to 11.8%, P for trend < .001, respectively). There was an associated increasing trend in survival to discharge in the overall population of patients with VT/VF OHCA (46.9% to 60.1%, P for trend < .001) in those with STE (59.2% to 74.3%, P for trend < .001) or without STE (43.3% to 56.8%, P for trend < .001).

Conclusions and Relevance  Coronary angiography, PCI, and survival to discharge have increased in VT/VF OHCA survivors from event to hospitalization. However, a significant proportion of patients with VT/VF OHCA, especially those without STE, do not undergo coronary angiography and revascularization. Prospective studies are needed to determine whether this limitation has a survival effect.

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