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Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry

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 betw...

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Autores principales: Song, Hwan, Kim, Hyo Joon, Park, Kyu Nam, Kim, Soo Hyun, Kim, Won Young, Lee, Byung Kook, Cho, In Soo, Lee, Jae Hoon, Youn, Chun Song
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865270/
https://www.ncbi.nlm.nih.gov/pubmed/33498728
http://dx.doi.org/10.3390/jcm10030439
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author Song, Hwan
Kim, Hyo Joon
Park, Kyu Nam
Kim, Soo Hyun
Kim, Won Young
Lee, Byung Kook
Cho, In Soo
Lee, Jae Hoon
Youn, Chun Song
author_facet Song, Hwan
Kim, Hyo Joon
Park, Kyu Nam
Kim, Soo Hyun
Kim, Won Young
Lee, Byung Kook
Cho, In Soo
Lee, Jae Hoon
Youn, Chun Song
author_sort Song, Hwan
collection PubMed
description 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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spelling pubmed-78652702021-02-07 Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry Song, Hwan Kim, Hyo Joon Park, Kyu Nam Kim, Soo Hyun Kim, Won Young Lee, Byung Kook Cho, In Soo Lee, Jae Hoon Youn, Chun Song J Clin Med Article 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. MDPI 2021-01-23 /pmc/articles/PMC7865270/ /pubmed/33498728 http://dx.doi.org/10.3390/jcm10030439 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Song, Hwan
Kim, Hyo Joon
Park, Kyu Nam
Kim, Soo Hyun
Kim, Won Young
Lee, Byung Kook
Cho, In Soo
Lee, Jae Hoon
Youn, Chun Song
Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry
title Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry
title_full Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry
title_fullStr Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry
title_full_unstemmed Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry
title_short Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry
title_sort which out-of-hospital cardiac arrest patients without st-segment elevation benefit from early coronary angiography? results from the korean hypothermia network prospective registry
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865270/
https://www.ncbi.nlm.nih.gov/pubmed/33498728
http://dx.doi.org/10.3390/jcm10030439
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