European Heart Journal: Acute Cardiovascular Care 1–10 © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2048872614564080 acc.sagepub.com EUROPEAN SOCIETY OF CARDIOLOGY ® Combining therapeutic hypothermia and emergent coronary angiography in out-of-hospital cardiac arrest survivors: Optimal post-arrest care for the best patient Gianni Casella 1 , Valeria Carinci 1 , Piergiorgio Cavallo 2 , Paolo Guastaroba 3 , Pier C Pavesi 1 , Maria G Pallotti 1 , Pietro Sangiorgio 1 , Gaetano Barbato 1 , Carlo Coniglio 2 , Bruno Iarussi 2 , Giovanni Gordini 2 and Giuseppe Di Pasquale 1 Abstract Background: Aggressive post-resuscitation care, in particular combining mild therapeutic hypothermia (MTH) with early coronary angiography (CAG) and percutaneous coronary intervention (PCI), may improve prognosis after out- of-hospital cardiac arrest (OHCA). Objectives: The study aims to assess the value of immediate CAG or PCI in comatose survivors after OHCA treated with MTH and their association with outcomes. Methods: Observational, prospective analysis of all comatose, resuscitated patients treated with MTH at a tertiary centre and undergoing CAG or PCI ≤6 hours after OHCA, or non-invasively managed. Primary outcomes were 30-day and 1-year survival. Results: From March 2004–December 2012, 141 (51%) out of 278 comatose patients after cardiac OHCA were treated with MTH (median age: 64.5 (interquartile range 55–73) years, males: 67%, first shockable rhythm: 70%, witnessed OHCA: 94%, interval OHCA-resuscitation≤20 min: 81%). Ninety-seven patients (69%) underwent early CAG, and 45 (32%) of them PCI. Patients undergoing CAG or PCI had a more favourable risk profile than subjects non-invasively managed. PCI treated patients had more bleedings, but no stent thrombosis occurred. Thirty-day and one-year unadjusted total mortality rates were 50% and 72% for non-invasively managed patients, 26% and 38.7% for patients submitted only to CAG and 32% and 36.6% for patients treated with PCI (p=0.0435 for early death, and p<0.0001 for one-year mortality, respectively). However, a propensity-matched score analysis did not confirm the survival advantage of invasive management (p=0.093). At multivariable analysis, clinical and OHCA-related variables as well as CAG, but not PCI, were associated with outcomes. Conclusions: Comatose patients cooled after OHCA and submitted to emergency CAG or PCI are a favourable outcome population that receives optimal post-arrest care. Keywords Cardiac arrest, coronary angiography, coronary intervention, hypothermia, outcome, survival Date received: 9 June 2014; accepted: 23 November 2014 1 Department of Cardiology, Maggiore Hospital, Bologna, Italy 2 Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna, Italy 3 Regional Health Care Agency, Regione Emilia-Romagna, Bologna, Italy 564080ACC 0 0 10.1177/2048872614564080European Heart Journal: Acute Cardiovascular CareCasella et al. research-article 2014 Original scientific paper Corresponding author: Gianni Casella, Department of Cardiology, Ospedale Maggiore, Largo Nigrisoli, 2–40133 Bologna, Italy. Email: gianni.casella@alice.it by guest on December 21, 2014 acc.sagepub.com Downloaded from