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Temporal trends in identification, management, and clinical outcomes after out-of-hospital cardiac arrest : insights from the Myocardial Ischaemia National Audit Project database
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Patterson, Tiffany, Perkins, Gavin D., Hassan, Yahma, Moschonas, Konstantinos, Gray, Huon, Curzen, Nick, de Belder, Mark, Nolan, Jerry P., Ludman, Peter and Redwood, Simon R. (2018) Temporal trends in identification, management, and clinical outcomes after out-of-hospital cardiac arrest : insights from the Myocardial Ischaemia National Audit Project database. Circulation: Cardiovascular Interventions, 11 (6). e005346. doi:10.1161/CIRCINTERVENTIONS.117.005346 ISSN 1941-7632.
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Official URL: https://doi.org/10.1161/CIRCINTERVENTIONS.117.0053...
Abstract
There is wide variation in survival rates from out-of-hospital cardiac arrest (OHCA) and overall survival remains poor. There is an expert consensus that early reperfusion therapy in ST-elevation reduces mortality. The management of patients without ST-elevation, however, is controversial. The Myocardial Ischaemia National Audit Project database is a national registry of all hospital admissions in England and Wales treated as an acute coronary syndrome (ACS). We examined temporal trends, over a 5-year period, of OHCAs identified by Myocardial Ischaemia National Audit Project, admitted to hospital and treated as ACS, the interventional management of these patients and clinical outcomes. Four hundred ten thousand four hundred sixty-two patients were admitted to hospital in England and Wales with ACS. Of these, 9421 presented with OHCA (2.30%). There was an increase in OHCA cases as a proportion of ACS between 2009 and 2013 (1.79% in 2009 versus 2.74% in 2013; <0.001). The rate of coronary angiography+percutaneous coronary intervention increased in ACS patients presenting with OHCA (54.9% in 2009 [876/1595] versus 66.3% in 2013 [884/1334]; <0.001). Cox proportional hazards model with time-varying exposure to coronary angiography demonstrated a significant reduction in mortality in both the ST-elevation (hazard ratio, 0.30; 95% confidence interval, 0.28-0.32; <0.05) and non-ST-elevation cohort (hazard ratio, 0.44; 95% confidence interval, 0.42-0.46; <0.001). Predictors of favorable outcome were synonymous with the selection criteria for patients undergoing coronary angiography±percutaneous coronary intervention. This observational study showed that selection for coronary angiography±percutaneous coronary intervention was associated with reduced mortality in OHCA patients diagnosed with ACS. These data support the need for a randomized controlled trial.
Item Type: | Journal Article | ||||||||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | ||||||||||||
Library of Congress Subject Headings (LCSH): | Cardiac arrest -- Treatment -- Statistics, Coronary arteries, Coronary heart disease | ||||||||||||
Journal or Publication Title: | Circulation: Cardiovascular Interventions | ||||||||||||
Publisher: | American Heart Association | ||||||||||||
ISSN: | 1941-7632 | ||||||||||||
Official Date: | 5 June 2018 | ||||||||||||
Dates: |
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Volume: | 11 | ||||||||||||
Number: | 6 | ||||||||||||
Article Number: | e005346 | ||||||||||||
DOI: | 10.1161/CIRCINTERVENTIONS.117.005346 | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||
Date of first compliant deposit: | 20 June 2018 | ||||||||||||
Date of first compliant Open Access: | 5 December 2018 | ||||||||||||
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