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Cardiovascular mortality and morbidity in patients undergoing percutaneous coronary intervention after out-of-hospital cardiac arrest: a systematic review and meta-analysis


Spirito, Alessandro; Gargiulo, Giuseppe; Siontis, George C M; Mitsis, Andreas; Billinger, Michael; Windecker, Stephan; Valgimigli, Marco (2021). Cardiovascular mortality and morbidity in patients undergoing percutaneous coronary intervention after out-of-hospital cardiac arrest: a systematic review and meta-analysis. EuroIntervention, 16(15):e1245-e1253.

Abstract

AIMS
To appraise the burden of cardiovascular mortality and morbidity among patients undergoing percutaneous coronary interventions (PCI) after out-of-hospital cardiac arrest (OHCA).
METHODS AND RESULTS
Meta-analysis of studies assessing the cardiovascular mortality or at least one other pre-defined outcomes in OHCA patients undergoing PCI. Forty-nine studies of 301,902 patients (73,634 OHCA and 228,268 non-OHCA patients) were included. Compared to non-OHCA patients, all-cause mortality was higher (29% vs 4%). The cause of 39% of deaths among OHCA patients was cardiovascular; PCI was more frequently unsuccessful (9.2% vs. 7.6%) and 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%). OHCA patients compared to non-OHCA patients had a higher risk of all-cause mortality (risk ratio 6.4, 95%CI, 5.5-7.4), cardiovascular death (4.6, 1.1-19), unsuccessful coronary revascularization (1.4, 1.1-1.7), stent thrombosis (3.8, 0.6-22.7), myocardial infarction (1.4, 1.1-1.7), relevant bleeding (3.2, 2.5-4.1) and stroke (3.1, 2.3-4.3).
CONCLUSIONS
Almost 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 the success rates of PCI lower among OHCA as compared to non-OHCA patients.

Abstract

AIMS
To appraise the burden of cardiovascular mortality and morbidity among patients undergoing percutaneous coronary interventions (PCI) after out-of-hospital cardiac arrest (OHCA).
METHODS AND RESULTS
Meta-analysis of studies assessing the cardiovascular mortality or at least one other pre-defined outcomes in OHCA patients undergoing PCI. Forty-nine studies of 301,902 patients (73,634 OHCA and 228,268 non-OHCA patients) were included. Compared to non-OHCA patients, all-cause mortality was higher (29% vs 4%). The cause of 39% of deaths among OHCA patients was cardiovascular; PCI was more frequently unsuccessful (9.2% vs. 7.6%) and 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%). OHCA patients compared to non-OHCA patients had a higher risk of all-cause mortality (risk ratio 6.4, 95%CI, 5.5-7.4), cardiovascular death (4.6, 1.1-19), unsuccessful coronary revascularization (1.4, 1.1-1.7), stent thrombosis (3.8, 0.6-22.7), myocardial infarction (1.4, 1.1-1.7), relevant bleeding (3.2, 2.5-4.1) and stroke (3.1, 2.3-4.3).
CONCLUSIONS
Almost 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 the success rates of PCI lower among OHCA as compared to non-OHCA patients.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 February 2021
Deposited On:11 Nov 2020 16:00
Last Modified:09 Feb 2021 02:05
Publisher:Europa Digital and Publishing
ISSN:1774-024X
OA Status:Green
Publisher DOI:https://doi.org/10.4244/EIJ-D-20-00221
Official URL:https://eurointervention.pcronline.com/article/cardiovascular-mortality-and-morbidity-in-patients-undergoing-percutaneous-coronary-intervention-after-out-of-hospital-cardiac-arrest-a-systematic-review-and-meta-analysis
PubMed ID:32624462

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