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.

AIM

The optimal coronary angiography (CAG) timing in out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE) for good neurologic outcome remains unknown. This study aimed to evaluate whether immediate versus early CAG impacts neurological outcomes of OHCA survivors without STE.

METHODS

This multicenter retrospective observational registry-based study was conducted at the emergency department (ED) of 8 Korean tertiary care hospitals. Data of adult non-traumatic OHCA patients with no obvious extra-cardiac cause, without STE, who were treated with targeted temperature management (TTM), and in whom CAG was performed within 24 h after return of spontaneous circulation between 2010 and 2015 were extracted. Patients in the immediate (≤2 h) and early (2-24 h) CAG groups were propensity score matched. The primary endpoint was 1-month good neurological outcomes.

RESULTS

Among 346 patients with TTM and CAG, 119 who underwent CAG after 24 h were excluded, leaving 112 and 115 in the immediate and early CAG groups, respectively. Median time to CAG was 120.0 (70.0-224.0) minutes; 97 (42.7%) patients had significant coronary artery stenosis. Good neurological outcome was higher in the early versus immediate CAG group (50.4% vs. 31.3%, P = 0.003), but no significant intergroup difference persisted after matching. CAG timing was not associated with good neurological outcomes (odds ratio, 1.917; 95% confidence interval, 0.954-3.852; P = 0.07).

CONCLUSIONS

Coronary artery stenosis was found in 42.7% of TTM-treated non-STE OHCA patients with CAG within 24 h, but there was no clear neurological benefit of immediate versus early CAG.