CV Mortality in Patients Undergoing PCI After Out-of-Hospital Cardiac Arrest Evaluated in Meta-Analysis

February 4, 2021—A systematic review and meta-analysis appraised the burden of cardiovascular mortality and morbidity among patients undergoing percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest (OHCA). Alessandro Spirito, MD, et al published the study’s findings in EuroIntervention (2021;16:e1245-e1253).

The meta-analysis included 49 studies assessing cardiovascular mortality or at least one other predefined outcome in OHCA patients undergoing PCI. A total of 301,902 patients (73,634 OHCA and 228,268 non-OHCA patients) comprised the meta-analysis population.

The study showed that approximately one-third of OHCA patients undergoing PCI die, and more than one-third of the fatalities are attributable to cardiovascular causes. The burden of ischemic and bleeding complications was consistently higher and PCI success rates lower among OHCA patients compared to non-OHCA patients, concluded the investigators in EuroIntervention.

Specifically, the investigators reported the following:

• All-cause mortality was higher in OHCA patients compared to non-OHCA patients (29% vs 4%).
• The cause of 39% of deaths among OHCA patients was cardiovascular.
• PCI was more frequently unsuccessful in OHCA patients versus non-OHCA patients (9.2% vs 7.6%).
• There were higher rates of stent thrombosis (2.9% vs 0.8%), myocardial infarction (1.7% vs 1.4%), relevant bleeding (10.2% vs 2.1%), and stroke (1.7% vs 0.5%) among OHCA patients versus non-OHCA patients.
• OHCA patients compared to non-OHCA patients had a higher risk of all-cause mortality (risk ratio [RR], 6.4; 95% CI, 5.5-7.4), cardiovascular death (RR, 4.6; 95% CI, 1.1-19), unsuccessful coronary revascularization (RR, 1.4; 95% CI, 1.1-1.7), stent thrombosis (RR, 3.8; 95% CI, 0.6-22.7), myocardial infarction (RR, 1.4; 95% CI, 1.1-1.7), relevant bleeding (RR, 3.2; 95% CI, 2.5-4.1), and stroke (RR, 3.1; 95% CI, 2.3-4.3).