Coronary Angiography Doubles Chance of Cardiac
Arrest Survival with Less Brain Damage
Suggests that clinicians should consider the
procedure for all post-cardiac arrest patients
What Is a Coronary Angiography?
An angiography tests for plaque in the coronary arteries. Learn
more about what happens during a coronary angiography.
Click to About.com video.
March 31, 2009 People who suffer cardiac arrests
and then receive coronary angiography are twice as likely to survive
without significant brain damage compared with those who don't have the
procedure, according to a study by University of Pittsburgh School of
Medicine researchers. Age was not a factor in the study.
The study, published in the May/June issue of the
Journal of Intensive Care Medicine and now available online,
showed that patient outcomes improved with coronary angiography, an
imaging procedure that shows how blood flows through the heart,
regardless of certain clinical and demographic factors that influenced
who received the procedure.
"Given the low odds of survival about 6 percent
for patients who suffer out-of-hospital cardiac arrests, it's important
to understand which treatments might make a difference in these dismal
outcomes," noted Jon C. Rittenberger, M.D., corresponding author of the
study and an assistant professor in the Department of Emergency Medicine
at the University of Pittsburgh.
EMS-treated cardiac arrest survival ranged from 3.0%
to 16.3%; ventricular fibrillation survival ranged from 7.7% to 39.9%
Link
to video in story
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The importance of prompt coronary angiography is
well-established for cardiac arrest patients presenting with certain
types of heart problems, Dr. Rittenberger noted.
"But our study, which shows that angiography is
independently associated with good neurologic outcomes, suggests that
clinicians should consider the procedure for all post-cardiac arrest
patients," he added.
Coronary angiography uses a contrast dye and X-rays
to see the blood vessels and chambers of the heart. The procedure is
usually done in conjunction with catheterization, which involves
threading a thin hollow tube through an artery and into the heart. Dye
is injected into the catheter and highlights any blockages in blood
flow, which are then visible by X-ray.
The researchers retrospectively analyzed the charts
of 241 adult cardiac arrest patients who were treated at UPMC
Presbyterian Hospital, part of the University of Pittsburgh Medical
Center, between January 1, 2005, and December 31, 2007.
Coronary artery disease was present in 52 percent
of the patients, and the rate did not differ between those who received
coronary angiography (40 percent of the group) and those who did not.
Those findings are consistent with prior research showing that 60 to 80
percent of cardiac arrests are a result of cardiovascular disease.
Just over half of patients who received coronary
angiography experienced a good clinical outcome defined as being
discharged to home or to an acute rehabilitation facility compared to
24.8 percent of patients who do not have the procedure.
Early angiography, performed within 24 hours of a
patient's arrival, was not associated with improved survival when
compared to having the procedure done later, but researchers noted that
the small number of patients may have made it impossible to prove a
difference.
"Coronary angiography appears to put patients on a
more proactive path of care, which may lead to a better outcome," said
Dr. Rittenberger. "As this study demonstrates, most of these cardiac
arrest patients have heart disease, which is often something that we can
fix. Many of the patients who get coronary angiography go on to get
bypass surgery, a balloon pump, a defibrillator or other such aggressive
treatments."
Rittenberger and his colleagues found no
significant differences between those who received angiography and those
who did not with respect to age, history of cardiac disease and use of
therapeutic hypothermia, a procedure used to cool patients who remain
comatose after resuscitation following cardiac arrest to prevent brain
damage.
However, patient sex, location of the arrest, the
initial heart rhythm disturbance and certain coronary and neurologic
abnormalities were among the predictors of who would receive
angiography.
Men who suffered cardiac arrests outside of the
hospital were more likely to have the procedure. The researchers also
found that coronary angiography was more likely to be performed on
patients with better neurological status. However, with the use of
therapeutic hypothermia, patients may not reveal their true neurological
state for several days after the return of spontaneous blood
circulation, they noted.
Information source:
Along with Dr. Rittenberger, authors of the paper
are Joshua C. Reynolds, M.D., previously at the University of Pittsburgh
and now at the University of Maryland; Clifton W. Callaway, M.D., Samar
R. El Khoudary, Ph.D., M.P.H., Charity G. Moore, Ph.D., M.S.P.H., and
Rene J. Alvarez, M.D., all of the University of Pittsburgh.
Dr. Rittenberger is supported by a grant from the
National Center for Research Resources, part of the National Institutes
of Health, and by a grant from the National Association of EMS
Physicians/Zoll EMS Resuscitation Research Fellowship.
To download the article in the Journal of Intensive
Care Medicine, please
click here.
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