Association of time from arrest to percutaneous coronary intervention with survival outcomes after out-of-hospital cardiac arrest.

Abstract

Background: Timely post-resuscitation coronary reperfusion therapy is recommended; however, the timing of immediate coronary reperfusion for out-of-hospital cardiac arrest (OHCA) has not been established. We studied the effect of the time interval from arrest to percutaneous coronary intervention (PCI) on resuscitated OHCA patients.Methods: All witnessed OHCA patients with a presumed cardiac etiology received successful PCI at hospitals between 2013 and 2015, excluding cases with unknown information regarding the time from arrest to PCI and survival outcomes. The main exposure of interest was the time interval from arrest to ballooning or stent placement in coronary arteries, and cases were categorized into five groups of 0-90, 90-120, 120-150, and 150-180 min and 3-6 h. The endpoint was survival with good neurological recovery. Multivariable logistic regression analysis was performed, adjusting for patient-community, prehospital, and hospital factors.Results: A total of 765 patients (24.1% received PCI within 90 min; 31.0% in 90-120 min; 17.8% in 120-150 min; 12.3% in 150-180 min; 14.9% in 3-6 h after arrest) were included. Good neurological recovery was more frequent in the early PCI groups than the delayed PCI group (63.6%, 55.3%, 47.8%, 33.0%, and 42.1%, respectively). The adjusted OR (95% CI) for good neurological recovery compared with the most early PCI group was 0.86 (0.53-1.39) in the PCI group between 90 and 120 min; 0.76 (0.45-1.31) in the PCI group between 120 and 150 min; 0.42 (0.22-0.79) in the PCI group between 150 and 180 min; and 0.53 (0.30-0.93) in PCI group after 3 h.Conclusions: Among resuscitated OHCA patients with a presumed cardiac etiology and successful PCI, patients who received a delayed coronary intervention after 150 min from arrest were less likely to have neurologically intact survival compared to those who received an early intervention. (C) 2017 Elsevier B.V. All rights reserved.