Increased risk of ventricular arrhythmias in survivors of out-of-hospital cardiac arrest with chronic total coronary occlusion

Abstract Introduction Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. Methods We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. Results A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2–35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. Conclusion In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event.

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TCT-529 Evaluation of the impact of a chronic total coronary occlusion on ventricular arrhythmias and long-term mortality in patients with ischemic cardiomyopathy and an implantable cardioverter-device (the eCTOpy-in-ICD study)

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.1711 ◽

2018 ◽

Vol 72 (13) ◽

pp. B213

Author(s):

Ivo M. van Dongen ◽

Dilek Yilmaz ◽

Joelle Elias ◽

Bimmer Claessen ◽

Ronak Delewi ◽

...

Keyword(s):

Ventricular Arrhythmias ◽

Ischemic Cardiomyopathy ◽

Coronary Occlusion ◽

Chronic Total Coronary Occlusion ◽

The Impact ◽

Long Term Mortality

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Relationship of Humidity and Atmospheric Pressure With the Risk of Out-of-hospital Cardiac Arrest

Journal of Holistic Nursing and Midwifery ◽

10.32598/jhnm.30.4.2036 ◽

2020 ◽

Vol 30 (4) ◽

pp. 224-232

Author(s):

Yasaman Borghei ◽

Mohammad Taghi Moghadamnia ◽

Abdolhossein Emami Sigaroudi ◽

Ehsan Kazemnezhad Leili

Keyword(s):

Climate Change ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Atmospheric Pressure ◽

Meteorological Data ◽

Weather Conditions ◽

Early Warning Systems ◽

Increased Risk ◽

Medical Care Team ◽

Hospital Cardiac Arrest

Introduction: Climate change, which affects human health, is one of the most important public health concerns. Few studies have examined the effects of humidity and atmospheric pressure as risk factors on the cardiac system and Out-of-hospital Cardiac Arrest. Objective: This study aimed to determine the relationship between climatic variables (humidity and atmospheric pressure) with Out-of-hospital Cardiac Arrest , and its outcome over 3 years (2016-2018). Materials and Methods: This is an ecological time-series study. Participants were 392 patients with Out-of-hospital Cardiac Arrest referred to Hospital in Rasht City, Iran from 2016 to 2018. Meteorological data and information related to Out-of-hospital Cardiac Arrest and its consequences were collected from reliable resources and were analyzed in R software. Results: Low humidity increased the relative risk of Out-of-hospital Cardiac Arrest (OR=1.54, 95%CI: 1.001-2.69, P=0.001) and failed cardiopulmonary resuscitation (OR=1.76, 95% CI; 1.006-3.79, P=0.001). Higher atmospheric pressure was associated with increased risk of Out-of-hospital Cardiac Arrest (OR=1.16, 95%CI; 1.001-1.78, P=0.001) and unsuccessful cardiopulmonary resuscitation (OR=1.039, 95% CI; 1.005-1.91, P=0.001). Conclusion: Decreased humidity and increased atmospheric pressure are associated with an increased number of Out-of-hospital Cardiac Arrest cases and failure of cardiopulmonary resuscitation. Informing people with cardiovascular disease to avoid such weather conditions, as well as preparing the medical care team and designing early warning systems, can reduce the adverse effects of climate change on the heart.

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Risk of out-of-hospital cardiac arrest among sepsis survivors in Taiwan: analysis of a nationwide population-based cohort

BMJ Open ◽

10.1136/bmjopen-2021-051502 ◽

2021 ◽

Vol 11 (9) ◽

pp. e051502

Author(s):

Wan-Ting Hsu ◽

Charles Fox Sherrod ◽

Babak Tehrani ◽

Alexa Papaila ◽

Lorenzo Porta ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Cox Regression ◽

Population Based ◽

National Database ◽

Secondary Outcome ◽

Research Database ◽

Increased Risk ◽

Matching Techniques ◽

Hospital Cardiac Arrest

ObjectivesThere is minimal literature examining the association of sepsis with out-of-hospital cardiac arrest (OHCA). Using a large national database, we aimed to quantify the risk of OHCA among sepsis patients after hospital discharge.DesignPopulation-based cohort study.SettingNationwide sepsis cohort retrieved from the National Health Insurance Research Database of Taiwan between 2000 and 2013.ParticipantsWe included 17 304 patients with sepsis. After hospital discharge, 144 patients developed OHCA within 30 days and 640 between days 31 and 365.Primary and secondary outcome measuresThe main outcomes were OHCA events following hospital discharge for sepsis. To evaluate the independent association between sepsis and OHCA after a sepsis hospitalisation, we constructed two non-sepsis comparison cohorts using risk set sampling and propensity score matching techniques (non-infection cohort, non-sepsis infection cohort). We plotted the daily number and daily risk of OHCA within 1 year of hospital discharge between sepsis and matched non-sepsis cohorts. We used Cox regression to evaluate the risk of early and late OHCA, comparing sepsis to non-sepsis patients.ResultsCompared with non-infected patients, sepsis patients had a higher rate of early (HR 1.66, 95% CI: 1.27 to 2.16) and late (HR 1.19, 95% CI: 1.06 to 1.33) OHCA events. This association was independent of age, sex or cardiovascular history. Compared with non-sepsis patients with infections, sepsis patients had a higher rate of both early (HR 1.28, 95% CI: 1.00 to 1.63) and late (HR 1.13, 95% CI: 1.01 to 1.27) OHCA events, especially among patients with cardiovascular disease (OR 1.35, 95% CI: 1.01 to 1.81).ConclusionsSepsis patients had increased risk of OHCA compared with matched non-sepsis controls, which lasted up to 1 year after hospital discharge.

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Clinical outcome of out-of-hospital vs. in-hospital cardiac arrest survivors presenting with ventricular tachyarrhythmias

Heart and Vessels ◽

10.1007/s00380-021-01976-y ◽

2021 ◽

Author(s):

Julian Müller ◽

Michael Behnes ◽

Tobias Schupp ◽

Linda Reiser ◽

Gabriel Taton ◽

...

Keyword(s):

Cardiac Arrest ◽

Propensity Score ◽

Propensity Score Matching ◽

Cox Regression ◽

Prognostic Impact ◽

Ventricular Tachyarrhythmias ◽

Increased Risk ◽

All Cause Mortality ◽

Hospital Cardiac Arrest

AbstractLimited data regarding the prognostic impact of ventricular tachyarrhythmias related to out-of-hospital (OHCA) compared to in-hospital cardiac arrest (IHCA) is available. A large retrospective single-center observational registry with all patients admitted due to ventricular tachyarrhythmias was used including all consecutive patients with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Survivors discharged after OHCA were compared to those after IHCA using multivariable Cox regression models and propensity-score matching for evaluation of the primary endpoint of long-term all-cause mortality at 2.5 years. Secondary endpoints were all-cause mortality at 6 months and cardiac rehospitalization at 2.5 years. From 2.422 consecutive patients with ventricular tachyarrhythmias, a total of 524 patients survived cardiac arrest and were discharged from hospital (OHCA 62%; IHCA 38%). In about 50% of all cases, acute myocardial infarction was the underlying disease leading to ventricular tachyarrhythmias with consecutive aborted cardiac arrest. Survivors of IHCA were associated with increased long-term all-cause mortality compared to OHCA even after multivariable adjustment (28% vs. 16%; log rank p = 0.001; HR 1.623; 95% CI 1.002–2.629; p = 0.049) and after propensity-score matching (28% vs. 19%; log rank p = 0.045). Rates of cardiac rehospitalization rates at 2.5 years were equally distributed between OHCA and IHCA survivors. In patients presenting with ventricular tachyarrhythmias, survivors of IHCA were associated with increased risk for all-cause mortality at 2.5 years compared to OHCA survivors.

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Abstract 310: Validation of the Cardiac Arrest Hospital Prognosis (CAHP) Score in an American Out-of-hospital Cardiac Arrest Cohort: Results From a Large Single Center Cardiac Arrest Registry

Circulation ◽

10.1161/circ.142.suppl_4.310 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Jason J Grady ◽

Katie A Atwell ◽

Tomo Oshimura ◽

Nima Ghasemzadeh

Keyword(s):

Cardiac Arrest ◽

Medical Center ◽

Cerebral Performance Category ◽

Serum Lactate ◽

Neurologic Outcome ◽

Temperature Management ◽

Single Center ◽

Neurologic Outcomes ◽

Increased Risk ◽

Hospital Cardiac Arrest

Background: The cardiac arrest hospital prognosis (CAHP) score has been shown in French studies to predict neurologic outcomes in patients who suffer an out-of-hospital cardiac arrest (OHCA), but this score has not been studied in an American cohort. We aimed to validate the CAHP score in an independent, single center, large cardiac arrest registry. Methods: Between January 2015 to June 2020 there were 925 patients who suffered OHCA and were transferred to Northeast Georgia Medical Center out of whom 450 patients survived to hospital admission. Cerebral Performance Category (CPC) score was used for assessment of neurologic outcome at discharge ranging from 1-5. The primary endpoint was poor neurologic outcome defined as CPC 3-5. Logistic regression was performed to identify independent predictors of poor neurologic outcome. Results: Included patients were mostly male 57% (256 of 450) with a mean age of 52±15. STEMI was present on 11% (51 of 450) and a shockable rhythm on 35% (150 of 450) of patients. Targeted temperature management (TTM) and a mechanical compression device (MCD) were used in 72% (327 of 450) and 74% (336 of 450) respectively. 76% (344 of 450) had a CPC of 3-5 at discharge. After adjusting for covariates, including gender, BMI, serum lactate level, witnessed arrest status, STEMI on ECG, and use of MCD and TTM, the only independent predictors of a CPC of 3-5 were CAHP score (p<0.001), witnessed cardiac arrest, (p=0.039, OR: 0.45) and STEMI on admission ECG (P=0.001, OR: 0.22). Compared with CAHP< 150, CAHP 150-200 and CAHP>200 were associated with a 12-fold (p<0.00001) and 79-fold (p<0.00001) increased risk of poor neurologic outcome. Area under ROC curve for CAHP score predicting neurologic outcome was 0.92 (95% CI: 0.89-0.94). Conclusion: Here we show, for the first time, in an independent, large American cardiac arrest registry that CAHP score predicts neurologic outcomes in patients with OHCA. Further research is needed to assess how this prognostication tool would help clinicians decide on early vs. delayed invasive strategy in patients with OHCA admitted to hospitals across the U.S.

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