Outcomes of in-hospital treatment of cardiac patients who survived cardiac arrest and experienced coronary angiography
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Submission date: 2017-11-29
Final revision date: 2018-01-12
Acceptance date: 2018-01-15
Publication date: 2018-02-02
Arch Med Sci Atheroscler Dis 2018;3(1):1–7
Introduction: As coronary artery disease is the most frequent cause of cardiac arrest, early invasive strategies may be beneficial for such patients. This study analyses the impact of in-hospital treatment on short-term outcomes of out-of-hospital cardiac arrest survivors.
Material and methods: Patients admitted to the Cardiac Intensive Care Unit of our hospital within 2-year period were prospectively included in the study.
Results: One-hundred-thirty-one patients were included in the study, which showed that in-hospital mortality increases uniformly with the severity of the coronary artery lesion (p = 0.044), but an effect of revascularization on number of deaths was not observed (p = 0.64). The presence of coma (p = 0.005) and the combination of male sex and age above 60-year as 2.2-fold (p = 0.048) increasing in-hospital mortality were found. The highest mortality rate occurred during the first 3 days and the death rate of the patients who survived this period is low. We found reduced left ventricular ejection fraction (OR = 6.54; 95% CI: 1.98–21.63; p = 0.002), non-ventricular fibrillation initial rhythm (OR = 2.94; 95% CI: 1.25–6.90; p = 0.014), unconscious at admission (OR = 6.46; 95% CI: 1.96–21.24; p = 0.002) and post-resuscitation coma (OR = 6.00; 95% CI: 2.63–13.66; p < 0.001) or encephalopathy (OR = 2.71; 95% CI: 1.9–6.72; p = 0.031) to be significant prognostic factors for higher in-hospital mortality rate.
Conclusions: We recommend immediate coronary interventions for all survivors of OHCA regardless of their state of consciousness and absence of ischaemic changes on ECG. Early intensive treatment for OHCA patients is indispensable, as the highest mortality rate is within the first 3 days after an event.