TY - JOUR
T1 - Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest
T2 - a nationwide study
AU - Tranberg, Tinne
AU - Lippert, Freddy K
AU - Christensen, Erika Frischknecht
AU - Stengaard, Carsten
AU - Hjort, Jakob
AU - Lassen, Jens Flensted
AU - Petersen, Frants
AU - Jensen, Jan Skov
AU - Bäck, Caroline
AU - Jensen, Lisette Okkels
AU - Ravkilde, Jan
AU - Bøtker, Hans Erik
AU - Terkelsen, Christian Juhl
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Aims To evaluate whether the distance from the site of event to an invasive heart centre, acute coronary angiography (CAG)/percutaneous coronary intervention (PCI) and hospital-level of care (invasive heart centre vs. local hospital) is associated with survival in out-of-hospital cardiac arrest (OHCA) patients. Methods and results Nationwide historical follow-up study of 41 186 unselected OHCA patients, in whom resuscitation was attempted between 2001 and 2013, identified through the Danish Cardiac Arrest Registry. We observed an increase in the proportion of patients receiving bystander CPR (18% in 2001, 60% in 2013, P > 0.001), achieving return of spontaneous circulation (ROSC) (10% in 2001, 29% in 2013, P> 0.001) and being admitted directly to an invasive centre (26% in 2001, 45% in 2013, P > 0.001). Simultaneously, 30-day survival rose from 5% in 2001 to 12% in 2013, P > 0.001. Among patients achieving ROSC, a larger proportion underwent acute CAG/PCI (5% in 2001, 27% in 2013, P> 0.001). The proportion of patients undergoing acute CAG/PCI annually in each region was defined as the CAG/PCI index. The following variables were associated with lower mortality in multivariable analyses: direct admission to invasive heart centre (HR 0.91, 95% CI: 0.89-0.93), CAG/PCI index (HR 0.33, 95% CI: 0.25-0.45), population density above 2000 per square kilometre (HR 0.94, 95% CI: 0.89-0.98), bystander CPR (HR 0.97, 95% CI: 0.95-0.99) and witnessed OHCA (HR 0.87, 95% CI: 0.85-0.89), whereas distance to the nearest invasive centre was not associated with survival. Conclusion Admission to an invasive heart centre and regional performance of acute CAG/PCI were associated with improved survival in OHCA patients, whereas distance to the invasive centre was not. These results support a centralized strategy for immediate post-resuscitation care in OHCA patients.
AB - Aims To evaluate whether the distance from the site of event to an invasive heart centre, acute coronary angiography (CAG)/percutaneous coronary intervention (PCI) and hospital-level of care (invasive heart centre vs. local hospital) is associated with survival in out-of-hospital cardiac arrest (OHCA) patients. Methods and results Nationwide historical follow-up study of 41 186 unselected OHCA patients, in whom resuscitation was attempted between 2001 and 2013, identified through the Danish Cardiac Arrest Registry. We observed an increase in the proportion of patients receiving bystander CPR (18% in 2001, 60% in 2013, P > 0.001), achieving return of spontaneous circulation (ROSC) (10% in 2001, 29% in 2013, P> 0.001) and being admitted directly to an invasive centre (26% in 2001, 45% in 2013, P > 0.001). Simultaneously, 30-day survival rose from 5% in 2001 to 12% in 2013, P > 0.001. Among patients achieving ROSC, a larger proportion underwent acute CAG/PCI (5% in 2001, 27% in 2013, P> 0.001). The proportion of patients undergoing acute CAG/PCI annually in each region was defined as the CAG/PCI index. The following variables were associated with lower mortality in multivariable analyses: direct admission to invasive heart centre (HR 0.91, 95% CI: 0.89-0.93), CAG/PCI index (HR 0.33, 95% CI: 0.25-0.45), population density above 2000 per square kilometre (HR 0.94, 95% CI: 0.89-0.98), bystander CPR (HR 0.97, 95% CI: 0.95-0.99) and witnessed OHCA (HR 0.87, 95% CI: 0.85-0.89), whereas distance to the nearest invasive centre was not associated with survival. Conclusion Admission to an invasive heart centre and regional performance of acute CAG/PCI were associated with improved survival in OHCA patients, whereas distance to the invasive centre was not. These results support a centralized strategy for immediate post-resuscitation care in OHCA patients.
KW - Journal Article
U2 - 10.1093/eurheartj/ehx104
DO - 10.1093/eurheartj/ehx104
M3 - Journal article
C2 - 28369362
SN - 0195-668X
VL - 38
SP - 1645
EP - 1652
JO - European Heart Journal
JF - European Heart Journal
IS - 21
ER -