Neurological outcomes and survival rate of out-of-hospital cardiac arrest patients with return of spontaneous circulation after percutaneous coronary intervention across age groups: a cross-sectional study

Kang, Min Woo; Lee, Jun Hee; Park, Jeong Ho

J Korean Soc Emerg Med > Volume 31(1); 2020 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2020;31(1): 1-9.

Neurological outcomes and survival rate of out-of-hospital cardiac arrest patients with return of spontaneous circulation after percutaneous coronary intervention across age groups: a cross-sectional study

Min Woo Kang¹, Jun Hee Lee¹

, Jeong Ho Park²

¹Department of Emergency Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
²Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea

Correspondence

Jun Hee Lee ,Tel: 031-390-2268, Fax: 031-390-2275, Email: inhaed@hanmail.net,

Received: May 29, 2019; Revised: October 23, 2019 Accepted: October 26, 2019. Published online: February 28, 2020.

ABSTRACT

Objective:
Little is known about percutaneous coronary intervention (PCI) and its benefits in elderly patients with out-of-hospital cardiac arrest (OHCA). This study compared the survival to discharge and the neurological outcomes across the age groups of patients with OHCA.
Methods:
Using the national cardiac arrest registry, OHCA patients with a return of spontaneous circulation from 2013 to 2017 were included in this study. The PCI history of the patients was obtained from their medical records. The outcomes were cerebral performance category (CPC) 1 and 2 and survival to discharge. Multivariable logistic regression analysis was performed, and an interaction term was evaluated to compare the effects of PCI across the age groups.
Results:
This study included 22,320 patients. In the interaction term, the adjusted odds ratio (AOR) (95% confidence interval [CI]) for a good CPC was 2.84 (2.43-3.32) for the age group of 18-64 years, 3.26 (2.53-4.21) for the age group of 65-74 years, 3.37 (2.33-4.88) for the age group of 75-84 years, and 2.54 (0.92-7.01) for the age group of 85-106 years. The AOR (95% CI) for survival to hospital discharge was 3.31 (2.82-3.88) for the age group of 18-64 years, 2.65 (2.09-3.35) for the age group of 65-74 years, 2.20 (1.61-3.02) for the age group of 75-84 years, and 1.64 (0.73-3.67) for the age group of 85-106 years.
Conclusion:
In the OHCA patients, the PCI group had more good outcomes (good CPC, survival to discharge) than the non-PCI group, but this benefit was not shown in those aged over 85 years. On the other hand, it could not explain why PCI should not be performed in the elderly, suggesting that age alone should not be used to make decisions regarding early invasive strategies.

Key words: Out-of-hospital cardiac arrest; Percutaneous coronary intervention; Elderly