Is early PCI associated with a clinical benefit in post-cardiac arrest patients without STEMI pattern? Insights from the Parisian registry (PROCAT II)

Rationale: Early PCI is associated with improved survival in out-of-hospital cardiac arrest (OHCA) patients resuscitated from a cardiac arrest of ischemic cause. However it is still unclear if this benefit is restricted to STEMI patients or if it can be extended to patients without STEMI on post-resuscitation ECG. We aimed to assess the influence of early PCI in this specific population. Methods: Providing that there is no obvious extra-cardiac cause, an immediate coronary angiogram is usually performed in all OHCA patients admitted in our hospital and all characteristics are prospectively collected in a computerized database. We isolated data from the subgroup of patients without STEMI on initial ECG. Using logistical regression, we investigated the association between early PCI and favourable outcome (defined with CPC 1 or CPC2) and we searched predictive factors for PCI requirement. Results: During the 10-years study period (2004-2013), 946 post-CA patients were explored by immediate coronary angiogram after OHCA. Among them, 704/946 (74%), mostly male (75%) and average age of 60 y.o. have no STEMI on the post-resuscitation ECG. PCI was deemed necessary in 203/704 (29%). A favourable outcome was observed in 86/203 (42%) in patients with PCI compared with 167/501 (33%) in patients without PCI (p=0.02). After adjustment on other covariates, PCI was associated with a better outcome (ORadj=1.79[1.08-2.95], p=0.02). Initial shockable rhythm (ORadj=3.03 [1.97-4.66], p Conclusion: We found a culprit coronary lesion requiring PCI in nearly one third of OHCA patients without STEMI. In these patients, PCI was associated with a nearly two-fold increase in the rate of favourable outcome. Identification of candidates of such strategy relies mostly on age and first observed rhythm. Our findings encourage the use of immediate coronary angiography in patients resuscitated from OHCA, even if there is no STEMI pattern on initial ECG.