Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest: a nationwide study.

AIMS: To evaluate whether the distance from the site of event to an invasive heart centre, acute coronary angiography (CAG)/percutaneous coronary intervention (PCI) and hospital-level of care (invasive heart centre vs. local hospital) is associated with survival in out-of-hospital cardiac arrest (OHCA) patients. METHODS AND RESULTS: Nationwide historical follow-up study of 41 186 unselected OHCA patients, in whom resuscitation was attempted between 2001 and 2013, identified through the Danish Cardiac Arrest Registry. We observed an increase in the proportion of patients receiving bystander CPR (18% in 2001, 60% in 2013, P < 0.001), achieving return of spontaneous circulation (ROSC) (10% in 2001, 29% in 2013, P < 0.001) and being admitted directly to an invasive centre (26% in 2001, 45% in 2013, P < 0.001). Simultaneously, 30-day survival rose from 5% in 2001 to 12% in 2013, P < 0.001. Among patients achieving ROSC, a larger proportion underwent acute CAG/PCI (5% in 2001, 27% in 2013, P < 0.001). The proportion of patients undergoing acute CAG/PCI annually in each region was defined as the CAG/PCI index. The following variables were associated with lower mortality in multivariable analyses: direct admission to invasive heart centre (HR 0.91, 95% CI: 0.89-0.93), CAG/PCI index (HR 0.33, 95% CI: 0.25-0.45), population density above 2000 per square kilometre (HR 0.94, 95% CI: 0.89-0.98), bystander CPR (HR 0.97, 95% CI: 0.95-0.99) and witnessed OHCA (HR 0.87, 95% CI: 0.85-0.89), whereas distance to the nearest invasive centre was not associated with survival. CONCLUSION: Admission to an invasive heart centre and regional performance of acute CAG/PCI were associated with improved survival in OHCA patients, whereas distance to the invasive centre was not. These results support a centralized strategy for immediate post-resuscitation care in OHCA patients.

Value of left ventricular filling parameters to predict mortality and functional class in patients with heart disease from the community.

UNLABELLED: Surprisingly few studies described the value of Doppler parameters in patients from the community. AIM: The aim was to determine the prevalence of prolonged IVRT (>0.105s) or a prolonged EDT (>0.280s) with a reduced E/A (<0.5) in heart patients from the community without valvular, systolic or rhythmic dysfunction. The associations of these parameters to all cause mortality and NYHA functional class were examined as well. METHODS: Seventy-two volunteer stable patients with a history of heart disease were identified from general practice. Patients with LVEF below 0.45, valvular abnormalities, atrial fibrillation, and pacemaker were excluded. Routine blood tests, echocardiography, chest X-ray, physical examination and mortality were evaluated. PATIENT FINDINGS: male 33%, mean age of 68 years, hypertension 82%, ischaemic heart disease 43%, and NYHA class I+II+III in 50+39+11%. Abnormal EDT occurred in 4% (95% CI from 0 to 9%), IVRT in 18% (9-27%), E/A in 0%. None had a restrictive pattern. EDT was longer in NYHA III than in NYHA I-II patients (median 0.25 vs. 0.19s, p=0.0006). E/A and IVRT were not associated with NYHA class or mortality. After 7.4 years 16 of 72 patients died. EDT predicted mortality in univariate analysis but not in a multivariate analysis where NYHA class and gender were the only significant predictors. CONCLUSION: Prolonged EDT was weakly associated to NYHA class and mortality while IVRT and E/A were not. Prolonged IVRT was a frequent finding, but a diagnosis of diastolic dysfunction is not supported by mild to moderate abnormal IVRT or E/A.