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Impact of Percutaneous Coronary Intervention on in Hospital Mortality in Cardiac Arrest - A National Perspective

Byomesh Tripathi, Shilpkumar Arora, Sidakpal Panaich, Sopan Lahewala, Nilay Patel, Viral Patel, Varun Kumar, Ashish Gupta, Abhishek Deshmukh, Eyal Herzog, Umesh Gidwani and Apurva Badheka

Objective of our study was to find out survival benefit of performing percutaneous coronary intervention (PCI) in patients with cardiac arrest. The study population was derived from the nationwide inpatient sample (NIS) database from 2008 to 2012. Cardiac arrest, ventricular fibrillation (Vfib), ventricular tachycardia (Vtach), asystole/pulseless electrical activity (PEA) and ST elevation myocardial infarction (STEMI) were identified using appropriate international classification of disease (ICD-9) diagnostic codes and PCI was identified using appropriate ICD-9 procedural code. The primary endpoint was in-hospital mortality. Multivariate analysis (odds ratio , 95% confidence interval, p value) showed increased mortality with older age (1.01, 1.01-1.02, p<0.001), higher comorbidities indicated by Charlson score (CCI) ≥ 2 (1.08, 104-1.18, p<0.001)as compare to CCI of 0, STEMI (1.44, 1.38-1.51, p<0.001), Shock (1.66, 1.61-1.71, p<0.001), self-pay/uninsured (1.48, 1.40-1.56, p<0.001) as compare to Medicare/Medicaid, admission on weekends (1.17,1.14 -1.20, p<0.001) as compared to admission during weekdays. While PCI (0.24, 0.23-0.25, p<0.001), higher socioeconomic status (SES) (0.86, 0.82-0.89, p<0.001) as compare to lower SES, private insurance (0.89, 95%CI: 0.86-0.92, p<0.001) as compared to Medicare/Medicaid, teaching hospitals (0.96, 0.90-0.99, p-0.016) as compared to non-teaching hospitals were associated with decreased mortality. Hospital located in the west region (1.08, 1.01 to 1.16, p=0.024) as compared to hospitals located in northeast region were associated with increased mortality. Subgroup analysis including high risk showed similar results. In conclusion PCI in cardiac arrest patients demonstrated improved survival irrespective of the type of cardiac arrest, presence of STEMI or shock.