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Benefit of immediate coronary angiography after out-of-hospital cardiac arrest in France: A nationwide propensity score analysis from the RéAC Registry

  • Author Footnotes
    1 Co-first authors.
    Déborah Jaeger
    Footnotes
    1 Co-first authors.
    Affiliations
    Emergency Department, University Hospital of Nancy, France

    INSERM, Clinical Investigation Center – Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France

    INSERM U1116, Université de Lorraine, Nancy, France
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  • Author Footnotes
    1 Co-first authors.
    Florence Dumas
    Footnotes
    1 Co-first authors.
    Affiliations
    Sudden Death Expertise Center, Cardiovascular Research Center (PARCC), INSERM Unit 970 (team 4), Paris, France

    Université Paris Descartes-Sorbonne Paris Cite, Paris, France

    Emergency Department, Cochin Hospital, Assistance Publique-Hopitaux de Paris (APHP) Paris, France
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  • Josephine Escutnaire
    Affiliations
    From University of Lille and RéAC, Lille, France

    SAMU, Lyon University Hospital, Lyon, France
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  • Sonia Sadoune
    Affiliations
    Emergency Department, University Hospital of Nancy, France
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  • Adrien Lauvray
    Affiliations
    Emergency Department, University Hospital of Nancy, France
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  • Carlos Elkhoury
    Affiliations
    Emergency Department and RESCUe Network, Lucien Hussel Hospital, France
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  • Adrien Bassand
    Affiliations
    Emergency Department, University Hospital of Nancy, France

    INSERM, Clinical Investigation Center – Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France
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  • Nicolas Girerd
    Affiliations
    INSERM, Clinical Investigation Center – Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France

    INSERM U1116, Université de Lorraine, Nancy, France

    Cardiology Department, CHRU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre-les, Nancy, France

    F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
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  • Pierre Yves Gueugniaud
    Affiliations
    Pôle “URMARS” Urgences – Réanimation Médicale – Anesthésie-Réanimation – SAMU, Groupement Hospitalier Edouard Herriot, Lyon, France

    Université Claude Bernard-Lyon 1, Lyon, France
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  • Karim Tazarourte
    Affiliations
    Pôle “URMARS” Urgences – Réanimation Médicale – Anesthésie-Réanimation – SAMU, Groupement Hospitalier Edouard Herriot, Lyon, France

    Université Claude Bernard-Lyon 1, Lyon, France
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  • Hervé Hubert
    Affiliations
    From University of Lille and RéAC, Lille, France

    SAMU, Lyon University Hospital, Lyon, France
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  • Alain Cariou
    Affiliations
    Sudden Death Expertise Center, Cardiovascular Research Center (PARCC), INSERM Unit 970 (team 4), Paris, France

    Université Paris Descartes-Sorbonne Paris Cite, Paris, France

    Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, Cedex 14, France
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  • Tahar Chouihed
    Correspondence
    Corresponding author at: Emergency Department, University Hospital of Nancy, France.
    Affiliations
    Emergency Department, University Hospital of Nancy, France

    INSERM, Clinical Investigation Center – Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France

    INSERM U1116, Université de Lorraine, Nancy, France

    F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
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  • the Reac Group
  • Author Footnotes
    1 Co-first authors.

      Abstract

      Background

      The survival rate of out-of-hospital cardiac arrest (OHCA) remains extremely low, generally under 10%. Post-resuscitation care, and particularly early coronary reperfusion, may improve this outcome. The main objective of the present study was to determine whether patients with immediate coronary angiography at hospital admission (CAA) had a better outcome than patients without immediate CAA.

      Methods

      This cohort analysis study was based on data extracted from the French National Cardiac Arrest registry (RéAC). To control for attribution bias, patients were matched using a propensity score, which included age clusters, low flow and no flow delays, initial rhythm and bystander cardiopulmonary resuscitation (CPR). The main endpoint was survival at day 30 (D30). Secondary endpoint was neurological recovery of survivors assessed by the Cerebral Performance Category (CPC) scale, with CPC 1 and 2 at D30 considered as a favorable outcome.

      Results

      From July 1st, 2011 to October 1st, 2016, 63394 OHCA were registered in the database, of which 39444 were of an unknown or suspected cardiac origin. After on-site resuscitation by a mobile medical team, 7584 patients were transported to a hospital facility. Among these patients, 4046 were retained in the analysis after matching for the aforementioned factors and constituted into 2 groups: immediate coronary angiography (iCAA) group (n = 2023) and non-immediate coronary angiography (niCAA) group (n = 2023). The survival rate at D30 after matching was 43.3% in the iCAA group versus 34.5% in the niCAA group (OD = 0.66 [0.58; 0.75], p < 0.001). In the iCAA group, (n = 707) 36% of the patients at D30 were CPC 1–2 comparatively to (n = 539) 27.3% in the niCAA group (p < 0.01).

      Conclusions

      Both the survival and proportion of patients with favorable neurological recovery were significantly higher in patients who underwent an immediate coronary angiography after a resuscitated OHCA. These observational results warrant further exploration of the benefit of this invasive strategy in randomized studies.

      Keywords

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