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Immediate PCI after cardiac arrestis associated with improvedshort and long term outcome

Guillaume Geri, Florence Dumas, Wulfran Bougouin, Olivier Varenne, Fabrice Daviaud, Frédéric Pène, Lionel Lamhaut, Jean-Daniel Chiche,

Christian Spaulding, Jean-Paul Mira, Jean-Philippe Empanaand Alain Cariou

Medical Intensive Care Unit, Cochin Hospital Paris, FranceSudden death expertise center, INSERM U970, Paris France

Conflict of interest

• None

High prevalence of recentcoronary occlusion after CA

• Spaulding C. NEJM 1997• 60/84 : 71% of recent coronary occlusion• Regardless ECG findings

• Dumas F. Circ Cardiovasc Interv 2010• 435 CA patients with coronary angiogram• ≥ 1 coronary artery occlusion : 304/435 (70%)• Successful PCI : 177/304 (58%)

Successful PCI is associated withimproved outcome

• Dumas F. J Am Coll Cardiol 2012

Adjusted HR0.46 [0.34,0.61]

Data are lacking on long-termoutcome

Small series

or

Inclusion biases

or

Few available data on in-hospital management

Objectives

• Describe short and long-term outcome in a large cohort of OHCA patients

• Evaluate pre and in-hospital factorsassociated with outcome

• Focus on successful PCI

Data collection

• From 2000 to 2013

• Data prospectively collected• Utstein style

• Intrahospital data• Early interventions (PCI, TTM, post resuscitation

shock, ICU death)

Diagnostic strategy at Cochin

Chelly J. Resuscitation 2012

Outcome assessment

2000-2013

1,722OHCA

patientssuccessfullyresuscitated

Short-term Long-term

Day-30 2013March 31st

Statistical analysis

• Short-term outcome• Logistic regression

• Long-term outcome• Multivariate Cox regression

• Matching• Propensity score

Baseline characteristics

All patientsN=1722

Male gender 1231 (71.5)Age < 60y 865 (50.2)Public place CA 555 (32.3)Initial VF/VT 941 (54.6)Witnessed CA 1426 (86.7)Bystander CPR 774 (46.1)Time from collapse to ROSC < 20mn 645 (43.1)Therapeutic hypothermia 1222 (71.0)Post resuscitation shock 1012 (58.8)

Short-term mortality1,722 OHCA patients

OR 95% CI

Age < 60 y 0.54 0.42,0.70Initial shockable rhythm 0.35 0.26,0.47Public location cardiac arrest 0.64 0.48,0.84Time from collapse to ROSC < 20min 0.23 0.18,0.30Witnessed CA 0.56 0.30,1.02Bystander CPR 0.64 0.49,0.84Therapeutic hypothermia 0.63 0.46,0.86

Male gender 1.05 0.78,1.42Post resuscitation shock 2.03 1.56,2.62

PCI 0.71 0.53,0.94

Short-term mortality1,722 OHCA patients

OR 95% CI

Age < 60 y 0.54 0.42,0.70Initial shockable rhythm 0.35 0.26,0.47Public location cardiac arrest 0.64 0.48,0.84Time from collapse to ROSC < 20min 0.23 0.18,0.30Witnessed CA 0.56 0.30,1.02Bystander CPR 0.64 0.49,0.84Therapeutic hypothermia 0.63 0.46,0.86

Male gender 1.05 0.78,1.42Post resuscitation shock 2.03 1.56,2.62

PCI 0.71 0.53,0.94

Mortality according to PCI466 survivors at day-30

HR 95% CI

Age < 60y 0.22 0.14,0.36Initial shockable rhythm 0.53 0.34,0.83Public location cardiac arrest 0.62 0.39,0.96

Male gender 1.64 0.99,2.74Witnessed CA 1.01 0.35,2.93Bystander CPR 0.86 0.56,1.32Resuscitation duration < 20min 1.26 0.78,2.04Post resuscitation shock 1.48 0.97,2.26Therapeutic hypothermia 1.12 0.67,1.87

PCI 0.41 0.25,0.68

Long-term outcome466 survivors at day-30

HR 95% CI

Age < 60y 0.22 0.14,0.36Initial shockable rhythm 0.53 0.34,0.83Public location cardiac arrest 0.62 0.39,0.96

Male gender 1.64 0.99,2.74Witnessed CA 1.01 0.35,2.93Bystander CPR 0.86 0.56,1.32Resuscitation duration < 20min 1.26 0.78,2.04Post resuscitation shock 1.48 0.97,2.26Therapeutic hypothermia 1.12 0.67,1.87

PCI 0.41 0.25,0.68

Long-term mortality466 survivors at day-30

Impact of PCI

Conclusion

• Favorable impact of immediate PCI• On short-term outcome• And on long-term outcome

• Should encourage physicians to systematically perfom coronary angiogramafter cardiac arrest

Procat study

Dumas F. Circ Cardiovasc Interv. 2010

AHA Tuesday, November 18