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Kanyal R, Pareek N, Sarma D, Bharucha A, Dworakowski R, Melikian N, Webb I, Shah A, MacCarthy P, Byrne J. Complete Revascularisation is associated with Improved Survival after Out of Hospital Cardiac Arrest. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Coronary artery disease (CAD) is common in patients with Out of Hospital Cardiac Arrest (OOHCA) but the clinical relevance of burden of CAD and evidence for revascularisation strategies in relation to outcomes and modes of death remains unclear.
Purpose
This study sought to assess the extent of CAD as defined by the SYNTAX score and prognostic value of complete compared with incomplete revascularisation by evaluating the SYNTAX revascularisation index (SRI) in patients with OOHCA.
Methods
619 patients with OOHCA were admitted at our centre between 1st May 2012 and 31st December 2017. 237 were excluded for having a non-cardiac aetiology or prior neurological disability. 398 patients were included into the study and of these 272 (68.3%) had early coronary angiography (CAG) and were included in the final analysis.
The baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) were determined from the coronary angiograms by a cardiologist blinded to the outcome. Patients were subdivided into 4 subgroups according to quartiles of the baseline syntax score (bSS) of 0, Group A: 1–10, Group B: 11–20 and Group C: ≥21. Complete revascularisation (CR) was defined as SRI of 1 and incomplete (IR) as SRI <1 where the SRI=(1-[rSS/bSS]) ×100 (Figure 1).
Results
Patients with a bSS of 0 were younger, had less shockable initial arrest rhythms and worse lactate and pH on arrival.Patients with bSS>0 (i.e., those with coronary artery disease) had similar cardiac arrest circumstances in terms of rates of witnessed, bystander CPR and shockable rhythms. Admission metabolic status reflected by pH and lactate and rates of ST elevation/LBBB were also identical for all three groups. However, LVEF on admission decreased significantly as coronary complexity increased (P<0.0001). While early angiography was more preferentially performed in those with higher coronary complexity, paradoxically, those with bSS 1–4 had highest rates of culprit lesions which was reflected in higher rates of PCI (Figure 1).
124 (45.4%) had CR compared with 54.2% with IR. CR was most likely to be achieved as the coronary complexity reduced (Group A – 71.7%, Group B – 41.1%, Group C - 23.3%). There was no difference in rates of cardiogenic shock between both groups (CR 61.1% vs. IR 69% p=ns), but patients with complete revascularisation were younger (58.8 vs 67.8, p<0.0001), lower rates of hypertension and previous CABG (16.2% vs 3.2%, p≤0.0001)
CR was associated with decreased mortality at 30 days (45.9% vs 34.6%, p=0.046) and 12 months (49.3% vs 35.4%, p=0.022). The lower mortality rate in CR appeared to partly be driven by lower cardiac deaths though this was not statistically significant (22% vs 7%, p=0.1) (Figure 2).
Conclusions
CR in a primary coronary aetiology OOHCA group is associated with reduced early and long-term mortality, which may be driven by a reduction in cardiac deaths. Prospective randomised trials in this population are warranted.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- R Kanyal
- King's College Hospital, London, United Kingdom
| | - N Pareek
- King's College Hospital, London, United Kingdom
| | - D Sarma
- King's College Hospital, London, United Kingdom
| | - A Bharucha
- King's College Hospital, London, United Kingdom
| | | | - N Melikian
- King's College Hospital, London, United Kingdom
| | - I Webb
- King's College Hospital, London, United Kingdom
| | - A Shah
- King's College Hospital, London, United Kingdom
| | - P MacCarthy
- King's College Hospital, London, United Kingdom
| | - J Byrne
- King's College Hospital, London, United Kingdom
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Moortgat-Pick G, Baer H, Battaglia M, Belanger G, Fujii K, Kalinowski J, Heinemeyer S, Kiyo Y, Olive K, Simon F, Uwer P, Wackeroth D, Zerwas PM, Arbey A, Asano M, Bagger J, Bechtle P, Bharucha A, Brau J, Brümmer F, Choi SY, Denner A, Desch K, Dittmaier S, Ellwanger U, Englert C, Freitas A, Ginzburg I, Godfrey S, Greiner N, Grojean C, Grünewald M, Heisig J, Höcker A, Kanemura S, Kawagoe K, Kogler R, Krawczyk M, Kronfeld AS, Kroseberg J, Liebler S, List J, Mahmoudi F, Mambrini Y, Matsumoto S, Mnich J, Mönig K, Mühlleitner MM, Pöschl R, Porod W, Porto S, Rolbiecki K, Schmitt M, Serpico P, Stanitzki M, Stål O, Stefaniak T, Stöckinger D, Weiglein G, Wilson GW, Zeune L, Moortgat F, Xella S, Bagger J, Brau J, Ellis J, Kawagoe K, Komamiya S, Kronfeld AS, Mnich J, Peskin M, Schlatter D, Wagner A, Yamamoto H. Physics at the [Formula: see text] linear collider. Eur Phys J C Part Fields 2015; 75:371. [PMID: 26300691 PMCID: PMC4537698 DOI: 10.1140/epjc/s10052-015-3511-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/09/2015] [Indexed: 06/04/2023]
Abstract
A comprehensive review of physics at an [Formula: see text] linear collider in the energy range of [Formula: see text] GeV-3 TeV is presented in view of recent and expected LHC results, experiments from low-energy as well as astroparticle physics. The report focusses in particular on Higgs-boson, top-quark and electroweak precision physics, but also discusses several models of beyond the standard model physics such as supersymmetry, little Higgs models and extra gauge bosons. The connection to cosmology has been analysed as well.
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Affiliation(s)
- G. Moortgat-Pick
- />II. Institute of Theoretical Physics, University of Hamburg, 22761 Hamburg, Germany
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - H. Baer
- />Department of Physics and Astronomy, University of Oklahoma, Norman, OK 73019 USA
| | - M. Battaglia
- />Santa Cruz Institute for Particle Physics, University of California Santa Cruz, Santa Cruz, CA USA
| | - G. Belanger
- />Laboratoire de Physique Theorique (LAPTh), Université Savoie Mont Blanc, CNRS, B.P.110, 74941 Annecy-le-Vieux, France
| | - K. Fujii
- />High Energy Accelerator Research Organisation (KEK), Tsukuba, Japan
| | - J. Kalinowski
- />Faculty of Physics, University of Warsaw, 02093 Warsaw, Poland
| | - S. Heinemeyer
- />Instituto de Física de Cantabria (CSIC-UC), 39005 Santander, Spain
| | - Y. Kiyo
- />Department of Physics, Juntendo University, Inzai, Chiba 270-1695 Japan
| | - K. Olive
- />William I. Fine Theoretical Physics Institute, School of Physics and Astronomy, University of Minnesota, Minneapolis, MN 55455 USA
| | - F. Simon
- />Max-Planck-Institut für Physik, 80805 Munich, Germany
| | - P. Uwer
- />Humboldt-Universität zu Berlin, Institut für Physik, 12489 Berlin, Germany
| | - D. Wackeroth
- />Department of Physics, SUNY at Buffalo, Buffalo, NY 14260-1500 USA
| | - P. M. Zerwas
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - A. Arbey
- />Université de Lyon, Université Lyon 1, 69622 Villeurbonne Cedex, France
- />Centre de Recherche Astrophysique de Lyon, CNRS, UMR 5574, 69561 Saint-Genis Laval Cedex, France
- />Ecole Normale Supérieure de Lyon, Lyon, France
| | - M. Asano
- />Physikalisches Institut and Bethe Center for Theoretical Physics, Universität Bonn, 53115 Bonn, Germany
| | - J. Bagger
- />Department of Physics and Astronomy, Johns Hopkins University, Baltimore, MD 21218 USA
- />TRIUMF, Vancouver, BC V6T 2A3 Canada
| | - P. Bechtle
- />Physikalisches Institut, University of Bonn, Bonn, Germany
| | - A. Bharucha
- />Physik Department T31, Technische Universität München, 85748 Garching, Germany
- />CNRS, Aix Marseille U., U. de Toulon, CPT, 13288 Marseille, France
| | - J. Brau
- />Department of Physics, University of Oregon, Eugene, OR 97403 USA
| | - F. Brümmer
- />LUPM, UMR 5299, Université de Montpellier II et CNRS, 34095 Montpellier, France
| | - S. Y. Choi
- />Department of Physics, Chonbuk National University, Jeonju, 561-756 Republic of Korea
| | - A. Denner
- />Universität Würzburg, Institut für Theoretische Physik und Astrophysik, 97074 Würzburg, Germany
| | - K. Desch
- />Physikalisches Institut, University of Bonn, Bonn, Germany
| | - S. Dittmaier
- />Physikalisches Institut, Albert–Ludwigs–Universität Freiburg, 79104 Freiburg, Germany
| | - U. Ellwanger
- />Laboratoire de Physique, UMR 8627, CNRS, Universite de Paris-Sud, 91405 Orsay, France
| | - C. Englert
- />SUPA, School of Physics and Astronomy, University of Glasgow, Glasgow, G12 8QQ UK
| | - A. Freitas
- />PITT PACC, Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - I. Ginzburg
- />Sobolev Institute of Mathematics and Novosibirsk State University, Novosibirsk, 630090 Russia
| | - S. Godfrey
- />Ottawa-Carleton Institute for Physics, Department of Physics, Carleton University, Ottawa, K1S 5B6 Canada
| | - N. Greiner
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
- />Max-Planck-Institut für Physik, 80805 Munich, Germany
| | - C. Grojean
- />ICREA at IFAE, Universitat Autonoma de Barcelona, 08193 Bellaterra, Spain
| | | | - J. Heisig
- />Institute for Theoretical Particle Physics and Cosmology, RWTH Aachen University, 52056 Aachen, Germany
| | | | - S. Kanemura
- />Department of Physics, University of Toyama, 3190 Gofuku, Toyama, 930-8555 Japan
| | - K. Kawagoe
- />Department of Physics, Kyushu University, 6-10-1 Hakozaki, Higashi-ku, Fukuoka, 812-8581 Japan
| | - R. Kogler
- />University of Hamburg, Hamburg, Germany
| | - M. Krawczyk
- />Faculty of Physics, University of Warsaw, 02093 Warsaw, Poland
| | - A. S. Kronfeld
- />Theoretical Physics Department, Fermi National Accelerator Laboratory, Batavia, IL USA
- />Institute for Advanced Study, Technische Universität München, 85748 Garching, Germany
| | - J. Kroseberg
- />Physikalisches Institut, University of Bonn, Bonn, Germany
| | - S. Liebler
- />II. Institute of Theoretical Physics, University of Hamburg, 22761 Hamburg, Germany
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - J. List
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - F. Mahmoudi
- />Université de Lyon, Université Lyon 1, 69622 Villeurbonne Cedex, France
- />Centre de Recherche Astrophysique de Lyon, CNRS, UMR 5574, 69561 Saint-Genis Laval Cedex, France
- />Ecole Normale Supérieure de Lyon, Lyon, France
| | - Y. Mambrini
- />Laboratoire de Physique, UMR 8627, CNRS, Universite de Paris-Sud, 91405 Orsay, France
| | - S. Matsumoto
- />Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583 Japan
| | - J. Mnich
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - K. Mönig
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - M. M. Mühlleitner
- />Institute for Theoretical Physics, Karlsruhe Institute of Technology, 76128 Karlsruhe, Germany
| | - R. Pöschl
- />Laboratoire de L’accelerateur Lineaire (LAL), CNRS/IN2P3, Orsay, France
| | - W. Porod
- />Universität Würzburg, Institut für Theoretische Physik und Astrophysik, 97074 Würzburg, Germany
| | - S. Porto
- />II. Institute of Theoretical Physics, University of Hamburg, 22761 Hamburg, Germany
| | - K. Rolbiecki
- />Faculty of Physics, University of Warsaw, 02093 Warsaw, Poland
- />Instituto de Fisica Teorica, IFT-UAM/CSIC, Universidad Autonoma de Madrid, Cantoblanco, 28049 Madrid, Spain
| | - M. Schmitt
- />Department of Physics and Astronomy, Northwestern University, Evanston, IL 60091 USA
| | - P. Serpico
- />Laboratoire de Physique Theorique (LAPTh), Université Savoie Mont Blanc, CNRS, B.P.110, 74941 Annecy-le-Vieux, France
| | - M. Stanitzki
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - O. Stål
- />The Oskar Klein Centre, Department of Physics, Stockholm University, 106 91 Stockholm, Sweden
| | - T. Stefaniak
- />Santa Cruz Institute for Particle Physics, University of California Santa Cruz, Santa Cruz, CA USA
| | - D. Stöckinger
- />Institut für Kern- und Teilchenphysik, TU Dresden, 01069 Dresden, Germany
| | - G. Weiglein
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - G. W. Wilson
- />Department of Physics and Astronomy, University of Kansas, Lawrence, KS 66045 USA
| | - L. Zeune
- />ITFA, University of Amsterdam, Science Park 904, 1018 XE Amsterdam, The Netherlands
| | | | - S. Xella
- />Niels Bohr Institute, University of Copenhagen, Kobenhavn, Denmark
| | - J. Bagger
- />Department of Physics and Astronomy, Johns Hopkins University, Baltimore, MD 21218 USA
- />TRIUMF, Vancouver, BC V6T 2A3 Canada
| | - J. Brau
- />Department of Physics, University of Oregon, Eugene, OR 97403 USA
| | - J. Ellis
- />CERN, Geneva, Switzerland
- />Theoretical Particle Physics and Cosmology Group, Department of Physics, King’s College London, Strand, London WC2R 2LS UK
| | - K. Kawagoe
- />Department of Physics, Kyushu University, 6-10-1 Hakozaki, Higashi-ku, Fukuoka, 812-8581 Japan
| | - S. Komamiya
- />Department of Physics, Graduate School of Science, and International Center for Elementary Particle Physics, The University of Tokyo, Tokyo, 113-0033 Japan
| | - A. S. Kronfeld
- />Theoretical Physics Department, Fermi National Accelerator Laboratory, Batavia, IL USA
- />Institute for Advanced Study, Technische Universität München, 85748 Garching, Germany
| | - J. Mnich
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - M. Peskin
- />SLAC, Stanford University, Menlo Park, CA, 94025 USA
| | | | - A. Wagner
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
- />University of Hamburg, Hamburg, Germany
| | - H. Yamamoto
- />Department of Physics, Tohoku University, Sendai, Miyagi Japan
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