Abstract 18040: Effect on Survival of an Early versus Late Coronary Angiography Approach in Patients With Out-of-hospital Cardiac Arrest Without ST-Segment Elevation Myocardial Infarction

Background: The optimal timing of coronary angiography (CA) if performed in the management of patients presenting with out-of-hospital cardiac arrest (OHCA) in the absence of ST-Segment elevation myocardial infarction (STEMI) has not been examined by any randomized controlled trial (RCT), though some retrospective studies have suggested benefit of an early approach. Methods: We performed a retrospective analysis of 93 consecutive patients with OHCA and shockable rhythm, without STEMI between July 2007 and April 2014. Patients were categorized by those receiving early (24 hrs.) CA, and the relationship between timing of CA and mortality was assessed, along with key relevant clinical and angiographic variables in each group (Table). Results: Among 93 patients, 45 (48%) received early CA and 48 (52%) late CA. Door-to-angiography median time was 69 (50, 89) minutes in patients undergoing early CA. Patients undergoing early CA were more likely to have a culprit lesion on CA (31% vs. 10%, p=0.01), and a trend toward more frequent PCI (31% vs. 15%, p =0.06) in comparison to late CA. However, they also had a higher baseline lactate level. Inpatient mortality was significantly higher in patients undergoing early CA (27%) compared to those undergoing late CA (4%) (p=0.002). Conclusions: In a series of 93 consecutive patients presenting with OHCA without STEMI, early CA was associated with higher mortality despite a higher frequency of culprit lesions and successful PCI. These results contrast with those from other post-hoc analyses and clearly demonstrate the need for a RCT comparing early vs. late CA in this patient population.