Prognostic factors on arrival at the emergency department in patients resuscitated from out-of-hospital cardiac arrest due to coronary artery disease

Abstract

Aim: The aim of this study is to clarify the prognostic factors for in-hospital and neurological outcomes on arrival at the emergency department ( ED ) in patients resuscitated from out-of hospital cardiac arrest ( OHCA ) due to coronary artery disease ( CAD ). Methods: Seventy-nine patients who were resuscitated from OHCA and transferred to the coronary care unit after exclusion of non-CAD cases in the emergency department were enrolled. Patients were divided into 2 groups, one was survivor ( S ), and the other was non-survivor ( NS ), and neurological outcome was evaluated using cerebral performance categories ( CPC ). We compared baseline characteristics, pre-hospital factors including the presence of witness, by-stander cardiopulmonary resuscitation, the initial rhythm at first contact, pre-hospital defibrillation, time interval from receipt of call to arrival at hospital and time from collapse to return of spontaneous circulation ( TROSC ), vital signs and standard 12-lead electrocardiographic ( ECG ) findings on arrival, and the clinical course afterwards including echocardiographic findings and angiographic findings. Results: The QRS duration was significantly longer and systolic blood pressure ( SBP ) was significantly lower in NS group than in S group ( 157.1±50.3 vs. 119.5±25.3 ms, p<0.001; 81.0±59.3 vs. 137.3±38.8 mmHg, p<0.001 ). Time interval from receipt of call to arrival at hospital was significantly longer and SBP was significantly lower in CPC3-5 group than in CPC1-2 group ( 48.6±11.1 vs. 38.3±13.3 min, p=0.002; 94.9±64.0 vs. 142.5±27.7 mmHg, p<0.001 ). Multiple logistic regression analysis showed the QRS duration ( Odds Ratio=1.070, p=0.043 ) and SBP ( Odds Ratio=0.901, p=0.033 ) were independent prognostic factors of survival and time interval from receipt of call to arrival at hospital ( Odds Ratio=1.082, p=0.021 ) and SBP ( Odds Ratio=0.973, p=0.023 ) were independent prognostic factors of neurological outcome. Conclusion: In patients resuscitated from OHCA due to CAD, independent prognostic factors on arrival at the ED for in-hospital survival were QRS duration on ECG and systolic blood pressure, and those for neurological outcome were time interval from receipt of call to arrival at hospital and systolic blood pressure.