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Song H, Kim HJ, Park KN, Kim SH, Kim WY, Lee BK, Cho IS, Lee JH, Youn CS. Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry. J Clin Med 2021; 10:jcm10030439. [PMID: 33498728 PMCID: PMC7865270 DOI: 10.3390/jcm10030439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022] Open
Abstract
The effect of early coronary angiography (CAG) in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation (STE) is still controversial. It is not known which subgroups of patients without STE are the most likely to benefit. The objective of this study was to evaluate the association between emergency CAG and neurologic outcomes and identify subgroups with improved outcomes when emergency CAG was performed. This prospective, multicenter, observational cohort study was based on data from the Korean Hypothermia Network prospective registry (KORHN-PRO) 1.0. Adult OHCA patients who were treated with targeted temperature management (TTM) without any obvious extracardiac cause were included. Patients were dichotomized into early CAG (≤24 h) and no early CAG (>24 h or not performed) groups. High-risk patients were defined as having the Global Registry of Acute Coronary Events (GRACE) score > 140, time from collapse to return of spontaneous circulation (ROSC) > 30 min, lactate level > 7.0 mmol/L, arterial pH < 7.2, cardiac enzyme elevation and ST deviation. The primary outcome was good neurologic outcome at 6 months after OHCA. Of the 1373 patients from the KORHN-PRO 1.0 database, 678 patients met the inclusion criteria. The early CAG group showed better neurologic outcomes at 6 months after cardiac arrest (CA) (adjusted odds ratio: 2.21 (1.27-3.87), p = 0.005). This was maintained even after propensity score matching (adjusted odds ratio: 2.23 (1.39-3.58), p < 0.001). In the subgroup analysis, high-risk patients showed a greater benefit from early CAG. In contrast, no significant association was found in low-risk patients. Early CAG was associated with good neurologic outcome at 6 months after CA and should be considered in high-risk patients.
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Affiliation(s)
- Hwan Song
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.S.); (H.J.K.); (K.N.P.)
| | - Hyo Joon Kim
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.S.); (H.J.K.); (K.N.P.)
| | - Kyu Nam Park
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.S.); (H.J.K.); (K.N.P.)
| | - Soo Hyun Kim
- Department of Emergency Medicine, Eunpyeong St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea;
| | - Won Young Kim
- Asan Medical Center, Department of Emergency Medicine, Ulsan University College of Medicine, Seoul 05505, Korea;
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju 61469, Korea;
| | - In Soo Cho
- Department of Emergency Medicine, Hanil General Hospital, Korea Electric Power Medical Corporation, Seoul 01450, Korea;
| | - Jae Hoon Lee
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan 49201, Korea;
| | - Chun Song Youn
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.S.); (H.J.K.); (K.N.P.)
- Correspondence: ; Tel.: +82-2-2258-1988; Fax: +82-2-2258-1997
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Kim YJ, Kim YH, Lee BK, Park YS, Sim MS, Kim SJ, Oh SH, Lee DH, Kim WY. 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. Resuscitation 2019; 135:30-36. [DOI: 10.1016/j.resuscitation.2018.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/26/2018] [Accepted: 12/10/2018] [Indexed: 02/05/2023]
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