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Intensive Care Medicine

, Volume 41, Issue 5, pp 856–864 | Cite as

Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography: a post hoc analysis from the TTM trial

  • J. Dankiewicz
  • N. Nielsen
  • M. Annborn
  • T. Cronberg
  • D. Erlinge
  • Y. Gasche
  • C. Hassager
  • J. Kjaergaard
  • T. Pellis
  • H. Friberg
Original

Abstract

Purpose

To investigate whether early coronary angiography (CAG) after out-of-hospital cardiac arrest of a presumed cardiac cause is associated with improved outcomes in patients without acute ST elevation.

Methods

The target temperature management after out-of-hospital cardiac arrest (TTM) trial showed no difference in all-cause mortality or neurological outcome between an intervention of 33 and 36 °C. In this post hoc analysis, 544 patients where the admission electrocardiogram did not show acute ST elevation were included. Early CAG was defined as being performed on admission or within the first 6 h after arrest. Primary outcome was mortality at the end of trial. A Cox proportional hazard model was created to estimate hazard of death, adjusting for covariates. In addition, a propensity score matched analysis was performed.

Results

A total of 252 patients (46 %) received early CAG, whereas 292 (54 %) did not. At the end of the trial, 122 of 252 patients who received an early CAG (48 %) and 159 of 292 patients who did not (54 %) had died. The adjusted hazard ratio for death was 1.03 in the group that received an early CAG; 95 % CI 0.80–1.32, p = 0.82. In the propensity score analysis early CAG was not significantly associated with survival.

Conclusions

In this post hoc observational study of a large randomized trial, early coronary angiography for patients without acute ST elevation after out-of-hospital cardiac arrest of a presumed cardiac cause was not associated with improved survival. A randomized trial is warranted to guide clinical practice.

Keywords

Cardiac arrest Coronary angiography Coronary intervention Hypothermia Outcome Survival 

Notes

Acknowledgments

Support was provided by independent research grants from the Swedish Heart–Lung Foundation, Arbetsmarknadens Försäkringsaktiebolag Insurance foundation, Swedish Research Council, Region Skåne (Sweden), National Health Service (Sweden), Thelma Zoegas Foundation, Krapperup Foundation, Thure Carlsson Foundation, Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research, Skåne University Hospital, TrygFonden (Denmark), European Clinical Research Infrastructures Network, European Union Interreg programme IV A.

Conflicts of interest

Hans Friberg, Niklas Nielsen, and Tommaso Pellis have received lecture fees from Bard Medical.

Supplementary material

134_2015_3735_MOESM1_ESM.docx (206 kb)
Supplementary material 1 (DOCX 205 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • J. Dankiewicz
    • 1
    • 2
  • N. Nielsen
    • 2
  • M. Annborn
    • 1
    • 2
  • T. Cronberg
    • 2
    • 3
  • D. Erlinge
    • 2
    • 4
  • Y. Gasche
    • 5
  • C. Hassager
    • 6
  • J. Kjaergaard
    • 6
  • T. Pellis
    • 7
  • H. Friberg
    • 1
    • 2
  1. 1.Department of Intensive and Perioperative CareSkåne University HospitalLundSweden
  2. 2.Department of Clinical SciencesLund UniversityLundSweden
  3. 3.Department of NeurologySkåne University HospitalLundSweden
  4. 4.Department of CardiologySkåne University HospitalLundSweden
  5. 5.Department of Intensive CareGeneva University HospitalGenevaSwitzerland
  6. 6.Department of Cardiology, The Heart CentreCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
  7. 7.Emergency Medical Service, Anaesthesia and Intensive CareSanta Maria degli Angeli HospitalPordenoneDenmark

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