Immediate versus early coronary angiography with targeted temperature management in out-of-hospital cardiac arrest survivors without ST-segment elevation: A propensity score-matched analysis from a multicenter registry

Youn Jung Kim, Yong Hwan Kim, Byung Kook Lee, Yoo Seok Park, Min Seob Sim, Su Jin Kim, Sang Hoon Oh, Dong Hoon Lee, Won Young Kim

Research output: Contribution to journalArticle

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Abstract

Aim: The optimal coronary angiography (CAG) timing in out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE) for good neurologic outcome remains unknown. This study aimed to evaluate whether immediate versus early CAG impacts neurological outcomes of OHCA survivors without STE. Methods: This multicenter retrospective observational registry-based study was conducted at the emergency department (ED) of 8 Korean tertiary care hospitals. Data of adult non-traumatic OHCA patients with no obvious extra-cardiac cause, without STE, who were treated with targeted temperature management (TTM), and in whom CAG was performed within 24 h after return of spontaneous circulation between 2010 and 2015 were extracted. Patients in the immediate (≤2 h) and early (2–24 h) CAG groups were propensity score matched. The primary endpoint was 1-month good neurological outcomes. Results: Among 346 patients with TTM and CAG, 119 who underwent CAG after 24 h were excluded, leaving 112 and 115 in the immediate and early CAG groups, respectively. Median time to CAG was 120.0 (70.0–224.0) minutes; 97 (42.7%) patients had significant coronary artery stenosis. Good neurological outcome was higher in the early versus immediate CAG group (50.4% vs. 31.3%, P = 0.003), but no significant intergroup difference persisted after matching. CAG timing was not associated with good neurological outcomes (odds ratio, 1.917; 95% confidence interval, 0.954–3.852; P = 0.07). Conclusions: Coronary artery stenosis was found in 42.7% of TTM-treated non-STE OHCA patients with CAG within 24 h, but there was no clear neurological benefit of immediate versus early CAG.

Original languageEnglish
Pages (from-to)30-36
Number of pages7
JournalResuscitation
Volume135
DOIs
Publication statusPublished - 2019 Feb 1

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Out-of-Hospital Cardiac Arrest
Propensity Score
Coronary Angiography
Survivors
Registries
Temperature
Coronary Stenosis
Tertiary Healthcare
Tertiary Care Centers
Nervous System
Hospital Emergency Service

Keywords

  • Cardiopulmonary resuscitation
  • Coronary angiography
  • Out-of-hospital cardiac arrest
  • Outcome
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Immediate versus early coronary angiography with targeted temperature management in out-of-hospital cardiac arrest survivors without ST-segment elevation : A propensity score-matched analysis from a multicenter registry. / Kim, Youn Jung; Kim, Yong Hwan; Lee, Byung Kook; Park, Yoo Seok; Sim, Min Seob; Kim, Su Jin; Oh, Sang Hoon; Lee, Dong Hoon; Kim, Won Young.

In: Resuscitation, Vol. 135, 01.02.2019, p. 30-36.

Research output: Contribution to journalArticle

Kim, Youn Jung ; Kim, Yong Hwan ; Lee, Byung Kook ; Park, Yoo Seok ; Sim, Min Seob ; Kim, Su Jin ; Oh, Sang Hoon ; Lee, Dong Hoon ; Kim, Won Young. / Immediate versus early coronary angiography with targeted temperature management in out-of-hospital cardiac arrest survivors without ST-segment elevation : A propensity score-matched analysis from a multicenter registry. In: Resuscitation. 2019 ; Vol. 135. pp. 30-36.
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abstract = "Aim: The optimal coronary angiography (CAG) timing in out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE) for good neurologic outcome remains unknown. This study aimed to evaluate whether immediate versus early CAG impacts neurological outcomes of OHCA survivors without STE. Methods: This multicenter retrospective observational registry-based study was conducted at the emergency department (ED) of 8 Korean tertiary care hospitals. Data of adult non-traumatic OHCA patients with no obvious extra-cardiac cause, without STE, who were treated with targeted temperature management (TTM), and in whom CAG was performed within 24 h after return of spontaneous circulation between 2010 and 2015 were extracted. Patients in the immediate (≤2 h) and early (2–24 h) CAG groups were propensity score matched. The primary endpoint was 1-month good neurological outcomes. Results: Among 346 patients with TTM and CAG, 119 who underwent CAG after 24 h were excluded, leaving 112 and 115 in the immediate and early CAG groups, respectively. Median time to CAG was 120.0 (70.0–224.0) minutes; 97 (42.7{\%}) patients had significant coronary artery stenosis. Good neurological outcome was higher in the early versus immediate CAG group (50.4{\%} vs. 31.3{\%}, P = 0.003), but no significant intergroup difference persisted after matching. CAG timing was not associated with good neurological outcomes (odds ratio, 1.917; 95{\%} confidence interval, 0.954–3.852; P = 0.07). Conclusions: Coronary artery stenosis was found in 42.7{\%} of TTM-treated non-STE OHCA patients with CAG within 24 h, but there was no clear neurological benefit of immediate versus early CAG.",
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T1 - Immediate versus early coronary angiography with targeted temperature management in out-of-hospital cardiac arrest survivors without ST-segment elevation

T2 - A propensity score-matched analysis from a multicenter registry

AU - Kim, Youn Jung

AU - Kim, Yong Hwan

AU - Lee, Byung Kook

AU - Park, Yoo Seok

AU - Sim, Min Seob

AU - Kim, Su Jin

AU - Oh, Sang Hoon

AU - Lee, Dong Hoon

AU - Kim, Won Young

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N2 - Aim: The optimal coronary angiography (CAG) timing in out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE) for good neurologic outcome remains unknown. This study aimed to evaluate whether immediate versus early CAG impacts neurological outcomes of OHCA survivors without STE. Methods: This multicenter retrospective observational registry-based study was conducted at the emergency department (ED) of 8 Korean tertiary care hospitals. Data of adult non-traumatic OHCA patients with no obvious extra-cardiac cause, without STE, who were treated with targeted temperature management (TTM), and in whom CAG was performed within 24 h after return of spontaneous circulation between 2010 and 2015 were extracted. Patients in the immediate (≤2 h) and early (2–24 h) CAG groups were propensity score matched. The primary endpoint was 1-month good neurological outcomes. Results: Among 346 patients with TTM and CAG, 119 who underwent CAG after 24 h were excluded, leaving 112 and 115 in the immediate and early CAG groups, respectively. Median time to CAG was 120.0 (70.0–224.0) minutes; 97 (42.7%) patients had significant coronary artery stenosis. Good neurological outcome was higher in the early versus immediate CAG group (50.4% vs. 31.3%, P = 0.003), but no significant intergroup difference persisted after matching. CAG timing was not associated with good neurological outcomes (odds ratio, 1.917; 95% confidence interval, 0.954–3.852; P = 0.07). Conclusions: Coronary artery stenosis was found in 42.7% of TTM-treated non-STE OHCA patients with CAG within 24 h, but there was no clear neurological benefit of immediate versus early CAG.

AB - Aim: The optimal coronary angiography (CAG) timing in out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE) for good neurologic outcome remains unknown. This study aimed to evaluate whether immediate versus early CAG impacts neurological outcomes of OHCA survivors without STE. Methods: This multicenter retrospective observational registry-based study was conducted at the emergency department (ED) of 8 Korean tertiary care hospitals. Data of adult non-traumatic OHCA patients with no obvious extra-cardiac cause, without STE, who were treated with targeted temperature management (TTM), and in whom CAG was performed within 24 h after return of spontaneous circulation between 2010 and 2015 were extracted. Patients in the immediate (≤2 h) and early (2–24 h) CAG groups were propensity score matched. The primary endpoint was 1-month good neurological outcomes. Results: Among 346 patients with TTM and CAG, 119 who underwent CAG after 24 h were excluded, leaving 112 and 115 in the immediate and early CAG groups, respectively. Median time to CAG was 120.0 (70.0–224.0) minutes; 97 (42.7%) patients had significant coronary artery stenosis. Good neurological outcome was higher in the early versus immediate CAG group (50.4% vs. 31.3%, P = 0.003), but no significant intergroup difference persisted after matching. CAG timing was not associated with good neurological outcomes (odds ratio, 1.917; 95% confidence interval, 0.954–3.852; P = 0.07). Conclusions: Coronary artery stenosis was found in 42.7% of TTM-treated non-STE OHCA patients with CAG within 24 h, but there was no clear neurological benefit of immediate versus early CAG.

KW - Cardiopulmonary resuscitation

KW - Coronary angiography

KW - Out-of-hospital cardiac arrest

KW - Outcome

KW - Percutaneous coronary intervention

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