Predicting factors for long-term survival in patients with out-of-hospital cardiac arrest - A propensity score-matched analysis.
Aged
Cardiopulmonary Resuscitation
/ methods
Coronary Angiography
Coronary Disease
/ diagnostic imaging
Electrocardiography
Female
Germany
/ epidemiology
Hospitalization
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest
/ epidemiology
Percutaneous Coronary Intervention
Propensity Score
Registries
Risk Factors
ST Elevation Myocardial Infarction
/ diagnostic imaging
Survivors
Triage
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
31
05
2019
accepted:
25
11
2019
entrez:
16
1
2020
pubmed:
16
1
2020
medline:
3
4
2020
Statut:
epublish
Résumé
Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death worldwide, with acute coronary syndromes accounting for most of the cases. While the benefit of early revascularization has been clearly demonstrated in patients with ST-segment-elevation myocardial infarction (STEMI), diagnostic pathways remain unclear in the absence of STEMI. We aimed to characterize OHCA patients presenting to 2 tertiary cardiology centers and identify predicting factors associated with survival. We retrospectively analyzed 519 patients after OHCA from February 2003 to December 2017 at 2 centers in Munich, Germany. Patients undergoing immediate coronary angiography (CAG) were compared to those without. Multivariate regression analysis and inverse probability treatment weighting (IPTW) were performed to identify predictors for improved outcome in a matched population. Immediate CAG was performed in 385 (74.1%) patients after OHCA with presumed cardiac cause of arrest. As a result of multivariate analysis after propensity score matching, we found that immediate CAG, return of spontaneous circulation (ROSC) at admission, witnessed arrest and former smoking were associated with improved 30-days-survival [(OR, 0.46; 95% CI, 0.26-0.84), (OR, 0.21; 95% CI, 0.10-0.45), (OR, 0.50; 95% CI, 0.26-0.97), (OR, 0.43; 95% CI, 0.23-0.81)], and 1-year-survival [(OR, 0.39; 95% CI, 0.19-0.82), (OR, 0.29; 95% CI, 0.12-0.7), (OR, 0.43; 95% CI, 0.2-1.00), (OR, 0.3; 95% CI, 0.14-0.63)]. In our study, immediate CAG, ROSC at admission, witnessed arrest and former smoking were independent predictors of survival in cardiac arrest survivors. Improvement in prehospital management including bystander CPR and best practice post-resuscitation care with optimized triage of patients to an early invasive strategy may help ameliorate overall outcome of this critically-ill patient population.
Sections du résumé
BACKGROUND
Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death worldwide, with acute coronary syndromes accounting for most of the cases. While the benefit of early revascularization has been clearly demonstrated in patients with ST-segment-elevation myocardial infarction (STEMI), diagnostic pathways remain unclear in the absence of STEMI. We aimed to characterize OHCA patients presenting to 2 tertiary cardiology centers and identify predicting factors associated with survival.
METHODS
We retrospectively analyzed 519 patients after OHCA from February 2003 to December 2017 at 2 centers in Munich, Germany. Patients undergoing immediate coronary angiography (CAG) were compared to those without. Multivariate regression analysis and inverse probability treatment weighting (IPTW) were performed to identify predictors for improved outcome in a matched population.
RESULTS
Immediate CAG was performed in 385 (74.1%) patients after OHCA with presumed cardiac cause of arrest. As a result of multivariate analysis after propensity score matching, we found that immediate CAG, return of spontaneous circulation (ROSC) at admission, witnessed arrest and former smoking were associated with improved 30-days-survival [(OR, 0.46; 95% CI, 0.26-0.84), (OR, 0.21; 95% CI, 0.10-0.45), (OR, 0.50; 95% CI, 0.26-0.97), (OR, 0.43; 95% CI, 0.23-0.81)], and 1-year-survival [(OR, 0.39; 95% CI, 0.19-0.82), (OR, 0.29; 95% CI, 0.12-0.7), (OR, 0.43; 95% CI, 0.2-1.00), (OR, 0.3; 95% CI, 0.14-0.63)].
CONCLUSIONS
In our study, immediate CAG, ROSC at admission, witnessed arrest and former smoking were independent predictors of survival in cardiac arrest survivors. Improvement in prehospital management including bystander CPR and best practice post-resuscitation care with optimized triage of patients to an early invasive strategy may help ameliorate overall outcome of this critically-ill patient population.
Identifiants
pubmed: 31940337
doi: 10.1371/journal.pone.0218634
pii: PONE-D-19-14873
pmc: PMC6961829
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0218634Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Circ Cardiovasc Qual Outcomes. 2015 May;8(3):268-76
pubmed: 25944632
Lancet. 1995 Aug 12;346(8972):417-21
pubmed: 7623574
Resuscitation. 2011 Aug;82(8):1036-40
pubmed: 21524837
Circulation. 2003 Oct 21;108(16):1939-44
pubmed: 14530198
Circ Cardiovasc Interv. 2010 Jun 1;3(3):200-7
pubmed: 20484098
Nat Rev Cardiol. 2014 Jul;11(7):374
pubmed: 24839976
Resuscitation. 2014 Nov;85(11):1533-40
pubmed: 25195073
Resuscitation. 2014 Jan;85(1):88-95
pubmed: 23927955
N Engl J Med. 2003 Jun 26;348(26):2626-33
pubmed: 12826637
Eur Heart J. 2006 Dec;27(23):2840-5
pubmed: 17082207
N Engl J Med. 2002 Feb 21;346(8):557-63
pubmed: 11856794
Crit Care Med. 1988 Oct;16(10):1053-8
pubmed: 3168495
Circulation. 2014 Nov 18;130(21):1868-75
pubmed: 25399395
N Engl J Med. 2017 May 4;376(18):1737-1747
pubmed: 28467879
Resuscitation. 2004 Dec;63(3):233-49
pubmed: 15582757
Resuscitation. 2010 Nov;81(11):1479-87
pubmed: 20828914
Resuscitation. 2005 Oct;67(1):75-80
pubmed: 16199289
N Engl J Med. 2001 Apr 26;344(17):1304-13
pubmed: 11320390
Eur Heart J. 2012 Oct;33(20):2569-619
pubmed: 22922416
Eur Heart J. 2016 Jan 14;37(3):267-315
pubmed: 26320110
Am J Cardiol. 2012 Dec 15;110(12):1723-8
pubmed: 22975468
Am J Cardiol. 2014 Jul 15;114(2):169-74
pubmed: 24878124
N Engl J Med. 2004 Aug 12;351(7):647-56
pubmed: 15306666
BMC Emerg Med. 2015 Feb 04;15:3
pubmed: 25648841
JACC Cardiovasc Interv. 2015 Jul;8(8):1031-1040
pubmed: 26117462
Am Heart J. 2009 Feb;157(2):312-8
pubmed: 19185639
Am J Cardiol. 2012 Feb 15;109(4):451-4
pubmed: 22100026