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KMID : 1100620170040020065
Clinical and Experimental Emergency Medicine
2017 Volume.4 No. 2 p.65 ~ p.72
Impact of early coronary angiography on the survival to discharge after out-of-hospital cardiac arrest
Shin Ji-Kyoung

Ko Eun-Sil
Cha Won-Chul
Lee Tae-Rim
Yoon Hee
Hwang Sung-Yeon
Shin Tae-Gun
Sim Min-Seob
Jo Ik-Joon
Song Keun-Jeong
Rhee Joong-Eui
Jeong Yeon-Kwon
Choi Jin-Ho
Abstract
Objective: Acute myocardial infarction is a major cause of out-of-hospital cardiac arrest (OHCA). Coronary angiography (CAG) enables diagnostic confirmation of coronary artery disease and subsequent revascularization, which might improve the prognosis of OHCA survivors. Non-randomized data has shown a favorable impact of CAG on prognosis for this population. However, the optimal timing of CAG has been debated.

Methods: The clinical outcomes of 607 OHCA patients registered in CAPTURES (Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance), a nationwide multicenter registry performed in 27 hospitals, were analyzed. Early CAG was defined as CAG performed within 24 hours of emergency department admission. The primary outcome was survival to discharge, with neurologically favorable status defined by cerebral performance category scores ¡Â2.

Results: Compared to patients without CAG (n=469), patients who underwent early CAG (n=138) were younger, more likely to be male, and more likely to have received bystander cardiopulmonary resuscitation, pre-hospital defibrillation, and revascularization (P<0.01 for all). Analysis of 115 propensity score-matched pairs showed that early CAG is associated with a 2.3-fold increase in survival to discharge with neurologically favorable status (P<0.001, all). Survival to discharge increased consistently according to the time interval between emergency department visit and CAG (P<0.05).

Conclusion: Early CAG of OHCA patients was associated with better survival and favorable neurologic outcomes at discharge. However, there was no clear time threshold for CAG that predicted survival to discharge.
KEYWORD
Early coronary angiography, Out-of-hospital cardiac arrest, Survival rate, Neurologic outcome
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