TY - JOUR
T1 - Long-term outcomes among out-of-hospital cardiac arrest survivors with reversible vs. non-reversible causes
AU - Barcella, Carlo Alberto
AU - Grunau, Brian E.
AU - Guan, Meijiao
AU - Hawkins, Nathaniel M.
AU - Deyell, Marc W.
AU - Andrade, Jason G.
AU - Helmer, Jennie S.
AU - Wong, Graham C.
AU - Kragholm, Kristian H.
AU - Humphries, Karin H.
AU - Christenson, Jim
AU - Fordyce, Christopher B.
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2024/10/1
Y1 - 2024/10/1
N2 - AIMS: A reversible cause of out-of-hospital cardiac arrest (OHCA) is vaguely defined in international guidelines as an identifiable transient or potentially correctable condition. However, studies evaluating long-term outcomes of patients experiencing OHCA due to reversible and non-reversible causes are lacking. We aimed to determine differences in long-term outcomes in OHCA survivors according to different aetiology.METHODS AND RESULTS: From the British Columbia Cardiac Arrest registry, adults with non-traumatic OHCA (2009-2016) surviving to hospital discharge were identified. Patients were categorized by OHCA aetiology combining reversibility and underlying ischaemic aetiology. The primary outcome was a composite of all-cause mortality, recurrent OHCA, or re-hospitalization for sudden cardiac arrest or ventricular arrhythmias. Using the Kaplan-Meier method and multivariable Cox regression models, we compared the risk of the composite outcome according to different OHCA aetiology. Of 1325 OHCA hospital-discharge survivors (median age 62.8 years, 77.9% male), 431 (32.5%) had reversible ischaemic, 415 (31.3%), non-reversible ischaemic, 99 (7.5%), reversible non-ischaemic, and 380 (28.7%), non-reversible non-ischaemic aetiologies. At 3 years post discharge, the Kaplan-Meier event-free rate was highest in patients with a reversible ischaemic aetiology [91%, 95% confidence interval (CI) 87-94%], and lowest in those with a reversible non-ischaemic aetiology (62%, 95% CI 51-72%). In multivariate analyses, compared with non-reversible non-ischaemic cause, reversible ischaemic cause was associated with a significantly lower hazard ratio (HR; 0.52, 95% CI 0.33-0.81), reversible non-ischaemic cause with a significantly higher HR (1.53, 95% CI 1.03-2.32), and non-reversible ischaemic cause with a non-significant HR (0.92, 95% CI 0.64-1.33) for the composite outcome.CONCLUSION: Compared to other aetiologies, the presence of a reversible ischaemic cause is associated with improved long-term OHCA outcomes.
AB - AIMS: A reversible cause of out-of-hospital cardiac arrest (OHCA) is vaguely defined in international guidelines as an identifiable transient or potentially correctable condition. However, studies evaluating long-term outcomes of patients experiencing OHCA due to reversible and non-reversible causes are lacking. We aimed to determine differences in long-term outcomes in OHCA survivors according to different aetiology.METHODS AND RESULTS: From the British Columbia Cardiac Arrest registry, adults with non-traumatic OHCA (2009-2016) surviving to hospital discharge were identified. Patients were categorized by OHCA aetiology combining reversibility and underlying ischaemic aetiology. The primary outcome was a composite of all-cause mortality, recurrent OHCA, or re-hospitalization for sudden cardiac arrest or ventricular arrhythmias. Using the Kaplan-Meier method and multivariable Cox regression models, we compared the risk of the composite outcome according to different OHCA aetiology. Of 1325 OHCA hospital-discharge survivors (median age 62.8 years, 77.9% male), 431 (32.5%) had reversible ischaemic, 415 (31.3%), non-reversible ischaemic, 99 (7.5%), reversible non-ischaemic, and 380 (28.7%), non-reversible non-ischaemic aetiologies. At 3 years post discharge, the Kaplan-Meier event-free rate was highest in patients with a reversible ischaemic aetiology [91%, 95% confidence interval (CI) 87-94%], and lowest in those with a reversible non-ischaemic aetiology (62%, 95% CI 51-72%). In multivariate analyses, compared with non-reversible non-ischaemic cause, reversible ischaemic cause was associated with a significantly lower hazard ratio (HR; 0.52, 95% CI 0.33-0.81), reversible non-ischaemic cause with a significantly higher HR (1.53, 95% CI 1.03-2.32), and non-reversible ischaemic cause with a non-significant HR (0.92, 95% CI 0.64-1.33) for the composite outcome.CONCLUSION: Compared to other aetiologies, the presence of a reversible ischaemic cause is associated with improved long-term OHCA outcomes.
KW - Aged
KW - British Columbia/epidemiology
KW - Cardiopulmonary Resuscitation/methods
KW - Cause of Death/trends
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Out-of-Hospital Cardiac Arrest/mortality
KW - Registries
KW - Retrospective Studies
KW - Survival Rate/trends
KW - Survivors/statistics & numerical data
KW - Time Factors
UR - http://www.scopus.com/inward/record.url?scp=85207906121&partnerID=8YFLogxK
U2 - 10.1093/ehjacc/zuae097
DO - 10.1093/ehjacc/zuae097
M3 - Journal article
C2 - 39208449
SN - 2048-8726
VL - 13
SP - 715
EP - 725
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
IS - 10
M1 - zuae097
ER -