Abstract 407: The Efficacy and Frequency of Early Left Heart Catheterization After Out of Hospital Cardiac Arrest Over That Last Decade

Background: The efficacy of early coronary intervention after return of spontaneous circulation (ROSC) from out of hospital cardiac arrest, (OHCA) is debated. A recent review of the Wayne County, (Mi) CARES dataset from 2014-18 noted that early LHC maintained the strongest correlation to survival to discharge with good neurological outcome, for all-cause OHCA. Though the overall rate of LHC remained relatively stable, there was a sizable reduction in early LHC and a comparable increase in late LHC in those with CPC 1 and 2 at discharge [

] Our objective is to utilize the national CARES data to analyze the effect of early LHC on survival with good neurological outcome and to describe the frequency and timing of LHC in OHCA.

Methods: This observational study included patients enrolled in the national CARES registry from 2013-21. For the outcome of LHC by year, chi square analysis was performed. Outcome was cerebral performance category, (CPC) (good <3 vs. poor

3) at hospital discharge. A propensity score (PS) model was constructed using variables predictive of LHC and good outcome to determine probability of LHC. The PS was then used in an inverse weighted random effects logistic regression model to determine the independent effect of early LHC on outcome.

Results: 132,758 individual cases were identified. Median age was 60.3 years (s.d. 16.6), 61.8% were male. Early coronary angiography was performed in 26,999 (20.3%) patients. Patients who underwent early angiography often had shockable rhythms (78.% vs 34%), suffered the OHCA in a public location (36.9% vs 26.1%%), and were witnessed cardiac arrests (80% vs 48%). For the full model the odds ratio for a good outcome after early LHC was 2.54 (95% CI 2.36 - 2.73). Only initial shockable rhythm was more predictive of a good outcome with an OR of 3.9. The proportion undergoing early catheterization declined from 27.6 % to 17.3% from 2013 to 2021; p < 0.0001), though the overall catheterization rate remained the same.

Conclusion: In patients with OHCA, early left heart catheterization retains a strong association with good neurological outcome at hospital discharge. The use of early left heart catheterization has declined significantly over the last 9 years.