Coronary interventions – Mini focus on out-of-hospital cardiac arrest and cardiogenic shock

Cardiovascular mortality and morbidity in patients undergoing percutaneous coronary intervention after out-of-hospital cardiac arrest: a systematic review and meta-analysis

EuroIntervention 2021;16:e1245-e1253. DOI: 10.4244/EIJ-D-20-00221

Alessandro Spirito
Alessandro Spirito1, MD; Giuseppe Gargiulo1,2, MD, PhD; George C.M. Siontis1, MD, PhD; Andreas Mitsis1, MD; Michael Billinger1, MD; Stephan Windecker1, MD; Marco Valgimigli1,3
1. Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland; 2. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy; 3. Cardiocentro Ticino, Lugano, Switzerland

Aims: The aim of this meta-analysis was to appraise the burden of cardiovascular mortality and morbidity among patients undergoing percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest (OHCA).

Methods and results: This was a meta-analysis of studies assessing the cardiovascular mortality or at least one other pre-defined outcome in OHCA patients undergoing PCI. Forty-nine studies with a total of 301,902 patients (73,634 OHCA and 228,268 non-OHCA patients) were included. Compared to non-OHCA patients, all-cause mortality was higher in OHCA patients (29% vs 4%). The cause of 39% of deaths among OHCA patients was cardiovascular: PCI was more frequently unsuccessful (9.2% vs 7.6%) and there were higher rates of stent thrombosis (2.9% vs 0.8%), myocardial infarction (1.7% vs 1.4%), relevant bleeding (10.2% vs 2.1%) and stroke (1.7% vs 0.5%). OHCA patients compared to non-OHCA patients had a higher risk of all-cause mortality (risk ratio [RR] 6.4, 95% CI: 5.5-7.4), cardiovascular death (4.6, 1.1-19), unsuccessful coronary revascularisation (1.4, 1.1-1.7), stent thrombosis (3.8, 0.6-22.7), myocardial infarction (1.4, 1.1-1.7), relevant bleeding (3.2, 2.5-4.1) and stroke (3.1, 2.3-4.3).

Conclusions: Almost one third of OHCA patients undergoing PCI die and more than one third of the fatalities are attributable to cardiovascular causes. The burden of ischaemic and bleeding complications was consistently higher and the success rates of PCI lower among OHCA as compared to non-OHCA patients.

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acs/nste-acsmiscellaneousout-of-hospital cardiac arrest
Coronary interventionsSTEMINSTEMI
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