ABSTRACT
INTRODUCTION: Most cardiac arrests in adults are related to coronary artery disease (CAD), and the role of early invasive cardiology procedures remains unclear. AIMS: We investigated the prognosis for patients hospitalized for out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who were referred within 24 hours to a tertiary cardiology department, with a focus on the role of early coronary angiography (CA) and percutaneous coronary intervention (PCI). METHODS: This was an observational, single-center study using retrospective and prospective cohorts. Consecutive patients hospitalized for OHCA or IHCA and referred within 24 hours to a cardiology department were included in the study. Survival until hospital discharge was the primary outcome. RESULTS: One hundred and forty-eight patients aged 71 (14) years were included, 68 hospitalized for OHCA, and 80 patients after IHCA. Overall, in-hospital survival in the study group was 45% (66/148). In a multivariable logistic regression model, independent predictors of death were ejection fraction (EF) ≤30% (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.69-10.03), blood oxygen saturation (SpO2) ≤90% (OR, 2.77; 95% CI, 1.19-6.46), non-ST-segement elevation myocardial infarction (NSTEMI) (OR, 2.71; 95% CI, 1.02-7.21). The risk of death was lower in patients who underwent early CA (OR, 0.28; 95% CI, 0.1-0.74) or received at least one defibrillation (OR, 0.11; 95% CI, 0.05-0.27), even after adjustment for other factors. CONCLUSIONS: In this series from a tertiary cardiac center, patients who underwent early CA had improved outcomes after cardiac arrest. In the multivariable logistic regression model, lower SpO2, lower EF, and NSTEMI were independent risk factors of death, whereas early CA and initial shockable rhythm improved survival.
Subject(s)
Cardiopulmonary Resuscitation , Non-ST Elevated Myocardial Infarction , Out-of-Hospital Cardiac Arrest , Percutaneous Coronary Intervention , Adult , Humans , Coronary Angiography/methods , Percutaneous Coronary Intervention/adverse effects , Retrospective Studies , Prospective Studies , Non-ST Elevated Myocardial Infarction/complications , Out-of-Hospital Cardiac Arrest/therapy , SurvivorsSubject(s)
Aorta/abnormalities , Aorta/diagnostic imaging , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/surgery , Echocardiography/methods , Stents , Blood Vessel Prosthesis , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgery , Diagnosis, Differential , Humans , Male , Middle AgedABSTRACT
Hemorrhagic stroke is a frequent cause of morbidity and mortality in Poland. It results from disruption of intracranial vessel wall continuity. We report a case of 66-years-old man with prosthetic aortic valve after three ischemic strokes treated with acenocoumarol who was admitted to hospital with vertigo and motoric aphasia. Computed tomography confirmed a hemorrhagic stroke related to anticoagulant treatment. We discussed the principles of management and therapeutic options in patients requiring long-term anticoagulation suffering from severe hemorrhagic complications.
