Percutaneous Coronary Intervention Reduces Mortality in Out-of-Hospital Cardiac Arrest after Acute Coronary Syndrome: An Outcomes-Based Study from the Nationwide Inpatient Sample Database

Abstract

Introduction: Mortality following cardiac arrest (CA) is extremely high, with rates as high as 91.5% after out-of-hospital cardiac arrest (OHCA) and 76.1% after in-hospital cardiac arrest (IHCA). This study assessed the clinical profile and outcomes of a large cohort of patients undergoing primary percutaneous coronary intervention (PCI) for OHCA to determine its effect on clinical outcomes and mortality. Methods: 247,456 patients with OHCA due to acute coronary syndrome (ACS) were abstracted from the Nationwide Inpatient Sample database (2001-2011). Results: Among 247,456 OHCA patients, 11,111 (4.5%) had PCI while 236,345 (95.5%) did not. Patients who underwent PCI were younger than those who did not receive PCI (64 vs. 66 years), p < 0.001. Caucasians (79.6%) and males (66.5%) were more likely to undergo PCI, while significantly fewer African Americans (AA) (7.7%) and Hispanics (6.5%) received PCI, p < 0.001. A significantly greater percentage of patients with private insurance (35.5%) or Medicare (47.4%) underwent PCI, p < 0.001. Overall mortality was significantly lower among those undergoing PCI (28.3% vs. 65.4%), p < 0.001. Multivariate analysis identified age >65 years, female gender, AA or Hispanic race, advanced cancer, and liver dysfunction as independent factors associated with increased mortality, while PCI conferred a survival advantage in OHCA, p < 0.001. Conclusion: Treatment with PCI was associated with a significant decrease in mortality. PCI was performed most often in Caucasians, males, patients > 50 years old, and those with Medicare. PCI significantly reduces mortality in OHCA patients and should be considered in all OHCA patients. Further investigation and development of methods to overcome the apparent socioeconomic barriers to PCI is required.