Interventional cardiology

Australian data may aid selection of patients for coronary angiography after OHCA


In-hospital mortality in patients presenting with an out-of-hospital cardiac arrest (OHCA) and shockable rhythm is high, however a new study has outlined some of the predictors for adverse outcomes.

A Victorian study of 213 patients presenting with OHCA and shockable rhythm between 2014 and 2018 found an in-hospital mortality rate of 38%.

The retrospective study, published in the American Journal of Cardiology, said non-selection for coronary angiography was a significant predictor of mortality (OR 4.5, 95% CI 1.5 to 14).

In-hospital mortality was 32% in the coronary angiography (CA) group compared to 61% in the no-CA group (p<0.01).

Other significant predictors of in-hospital mortality were requiring adrenaline support on admission (OR 3.9, 1.3 to 12), arrest at home (OR 2.7, 1 to 6.6), longer time to defibrillation (OR 2.5, 1.5 to 4.2 per 5-minute increase), lower blood pH (OR 2.1, 1.4 to 3.2 per 0.1 decrease), lower albumin (OR 2.0, 1.2 to 3.3), higher APACHE II score (OR 1.7, 1.0 to 3.0 per 5-point increase), and advanced age (OR 1.4, 1.0 to 2.0).

“Multivariable logistic regression analysis demonstrated that having STE on initial ECG (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.2 to 6.2) was associated with selection for CA, whereas lower albumin (OR 0.65, 0.44 to 0.96 per 5-g/L decrease), CKD (OR 0.19, 0.05 to 0.68), and initial GCS ≤8 (OR 0.16, 0.03 to 0.81) were associated with non-selection for CA (all p<0.05).”

“Taken together, these data suggest that patients are selected for CA based on variables associated with a likely culprit lesion (acute ischaemic ECG changes) and perceived favourable prognosis after OHCA (early and effective resuscitation, absence of major co-morbidities, and favourable neurological status arrest).”

The study, led by Dr Wayne Zheng and with senior investigator Associate Professor William Chan from the Alfred Hospital, said knowledge of adverse predictors of in-hospital mortality had the potential to aid in prognostication.

“These data underscore the contemporary real-world practice of patient selection for invasive coronary assessment, highlighting physician judgment and clinical decision-making with respect to the initial assessment and treatment of these critically ill patients.”

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