Modulating effects of immediate neuroprognosis on early coronary angiography and targeted temperature management following out-of-hospital cardiac arrest: A retrospective cohort study

Abstract Background: To evaluate the associations between glycated hemoglobin (HbA1c) at admission and 6-month mortality and outcomes after out-of-hospital cardiac arrest (OHCA) treated by hypothermic targeted temperature management (TTM).Methods: This single-center retrospective cohort study included adult OHCA survivors who underwent hypothermic TTM from December 2011 to December 2019. High HbA1c at admission was defined as a level higher than 6%. Poor neurological outcomes were defined as cerebral performance category scores of 3-5. The primary outcome was 6-month mortality. The secondary outcome was the 6-month neurological outcome. Descriptive statistics, log-rank tests, and multivariable regression modeling were used for data analysis.Results: Of the 302 patients included in the final analysis, 102 patients (33.8%) had HbA1c levels higher than 6%. The high HbA1c group had significantly worse 6-month survival (12.7% vs. 37.5%, p < 0.001) and 6-month outcomes (89.2% vs. 73.0%, p = 0.001) than the non-high HbA1c group. Kaplan-Meier analysis and the log-rank test showed that the survival time was significantly shorter in the patients with HbA1c >6% than in those with HbA1c ≤6%. In the multivariable logistic regression analysis, HbA1c >6% was independently associated with 6-month mortality (OR 5.85, 95% CI 2.26-15.12, p < 0.001) and poor outcomes (OR 4.18, 95% CI 1.41-12.40, p < 0.001).Conclusions: This study showed that HbA1c higher than 6% at admission was associated with increased 6-month mortality and poor outcomes in OHCA survivors treated with hypothermic TTM. Poor long-term glycemic management may have prognostic significance after cardiac arrest.

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Association Between Target Temperature Variability and Neurologic Outcomes for Patients Receiving Targeted Temperature Management at 36°C After Cardiac Arrest: A Retrospective Cohort Study

Therapeutic Hypothermia and Temperature Management ◽

10.1089/ther.2020.0005 ◽

2020 ◽

Cited By ~ 1

Author(s):

Makayla Cordoza ◽

Hilaire Thompson ◽

Elizabeth Bridges ◽

Robert Burr ◽

David Carlbom

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Temperature Variability ◽

Targeted Temperature Management ◽

Temperature Management ◽

Target Temperature ◽

Neurologic Outcomes

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Prevalence and outcomes of out-of-hospital cardiac arrest survivors with left main or triple vessel coronary diseases: A multi-center, retrospective cohort study

10.21203/rs.3.rs-133537/v1 ◽

2020 ◽

Author(s):

Youn-Jung Kim ◽

Duk-Woo Park ◽

Yong Hwan Kim ◽

Minwoo Choi ◽

Su Jin Kim ◽

...

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Coronary Angiography ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Complete Revascularization ◽

Left Main ◽

The Impact ◽

Neurologically Intact ◽

Hospital Cardiac Arrest

Abstract Background While multivessel coronary artery disease (CAD) is frequently observed in out-of-hospital cardiac arrest (OHCA) survivors, little is known about the impact of revascularization strategy on outcomes. We aimed to evaluate the prevalence of left main or triple vessel CAD in comatose survivors of OHCA and assess their outcome based on the revascularization strategy. Methods This multicenter retrospective cohort study was conducted at 9 Korean tertiary care hospitals. Adult comatose OHCA survivors with left main or triple vessel CAD documented by immediate (≤ 2 hours) coronary angiography after return of spontaneous circulation between 2011 and 2019 were included. The primary outcome was neurologically intact survival at 1-month defined as survival with a Cerebral Performance Category score of 1–2. Results Among 727 OHCA patients with immediate coronary angiography, 150 (25.3%) with left main or triple vessel CAD were identified and categorized into complete (N = 32), incomplete (N = 78), and no immediate (N = 40) revascularization groups. The rate of neurologically intact survival at 1 month was significantly different among the groups (53.1%, 32.1%, and 22.5% for complete, incomplete, and no immediate revascularization groups, respectively; P = 0.021). After adjustment using the inverse probability of treatment weighting, complete revascularization was independently associated with neurologically intact survival at 1 month (odds ratio, 2.635; 95% confidence interval, 1.128–6.155; P = 0.012). Conclusions Left main or triple vessel CAD is not uncommon in comatose OHCA patients. The rate of neurologically intact survival at 1 month was 34.0%, and it was significantly greater in patients with complete revascularization than in patients with incomplete or no immediate revascularization. Further clinical trials will be needed to confirm the best revascularization strategy to improve outcomes in such critically ill patients.

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