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Immediate coronary angiography and systematic targeted temperature management are associated with improved outcome in comatose survivors of cardiac arrest

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Abstract

Rapid and systematic access to coronary angiography (CAG) and target temperature management (TTM) might improve outcome in comatose patients who survive cardiac arrest (CA). However, there is controversy around indicating immediate CAG in the absence of transmural ischemia on the electrocardiogram after return of spontaneous circulation (ROSC). We evaluated the short- and long-term outcome of patients undergoing systematic CAG and TTM, based on whether culprit lesion percutaneous coronary intervention (PCI) was performed. All consecutive comatose CA survivors without obvious extra-cardiac causes undergoing TTM were included. Analysis involved the entire population and subgroups, namely patients with initial unshockable rhythm, no ST elevation on electrocardiogram, and good neurological recovery. We enrolled 107 patients with a median age of 64.9 (57.7–73.6) years. The initial rhythm was shockable in 83 (77.6%). Sixty-six (61.7%) patients underwent PCI. In-hospital survival was 71%. It was 78.8% and 58.5% in those undergoing or not PCI (p = 0.022), respectively. Age, time from CA to ROSC and culprit lesion PCI were independent predictors of in-hospital survival. Long-term survival was significantly higher in patients who underwent PCI (respectively 61.5% vs 34.1%; Log-rank: p = 0.002). Revascularization was associated with better outcomes regardless of initial rhythm (shockable vs non-shockable) and ST deviation (elevation vs no-elevation), and improved the long-term survival of patients discharged with good neurological recovery. Systematic CAG and revascularization, when indicated, were associated with higher survival in comatose patients undergoing TTM, regardless of initial rhythm and ST deviation in the post-ROSC electrocardiogram. The benefit was sustained at long-term particularly in those with neurological recovery.

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Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Cardiovascular Department ASL Romagna Cardiology Unit, Morgagni-Pierantoni Hospital, via Forlanini 34, 47121, Forlì, Italy

    Gianni Dall’Ara, Miriam Compagnone, Daniela Spartà, Roberto Carletti, Simone Grotti, Luciano Caravita, Fabio Tarantino & Marcello Galvani

  2. Cardiology Unit, Bufalini Hospital, Cesena, Italy

    Giuseppe Guerrieri

  3. Anaesthesia and Intensive Care Unit, Morgagni-Pierantoni Hospital, Forlì, Italy

    Stefano Gaetani & Stefano Maitan

  4. Emergency Department, Morgagni-Pierantoni Hospital, Forlì, Italy

    Marco Cortigiani & Andrea Fabbri

  5. Cardiology Department, Vizzolo Predabissi Hospital, Melegnano, Milan, Italy

    Filippo Ottani

  6. Cardiovascular Research Unit, Myriam Zito Sacco Heart Foundation, Forlì, Italy

    Filippo Ottani & Marcello Galvani

Authors
  1. Gianni Dall’Ara
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  2. Miriam Compagnone
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Correspondence to Gianni Dall’Ara.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local ethics committee (ID 2589) and was conducted in accordance with the ethical guidelines of the Declaration of Helsinki and its later amendments.

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All procedures were approved by the Ethic Committee of the healthcare public agency of Romagna.

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Informed consent acquisition followed the instructions of the local ethics committee.

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Supplementary Information

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11739_2022_3011_MOESM1_ESM.tif

Supplementary file1 (TIF 172 KB) Supplementary Figure 1. Cardiac arrest patient flow and post-ROSC management protocol. EEG: electroencephalogram; MR: magnetic resonance; SSEP: somatosensitive evoked potentials

Supplementary file2 (TIF 106 KB) Supplementary Figure 2. Final diagnosis in the study population

11739_2022_3011_MOESM3_ESM.tif

Supplementary file3 (TIF 44 KB) Supplementary Figure 3. Kaplan–Meier long-term survival according to target temperature goal

Supplementary file4 (DOCX 20 KB)

Supplementary file5 (DOCX 20 KB)

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Dall’Ara, G., Compagnone, M., Spartà, D. et al. Immediate coronary angiography and systematic targeted temperature management are associated with improved outcome in comatose survivors of cardiac arrest. Intern Emerg Med 17, 2083–2092 (2022). https://doi.org/10.1007/s11739-022-03011-y

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  • DOI: https://doi.org/10.1007/s11739-022-03011-y

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