Out-of-hospital cardiac arrest: data from the National Registry of Invasive Cardiology Procedures (ORPKI) in a long-term survival analysis of patients with acute coronary syndromes in a Polish region

BACKGROUND Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death in high-income countries. AIMS This study aimed to analyze long-term survival in patients with OHCA in the Swietokrzyskie Province, who were included in the National Registry of Invasive Cardiology Procedures (ORPKI), estimate survival probability, and evaluate associated risk factors. METHODS Based on the ORPKI registry, we identified subjects with OHCA prior to hospitalization. Data were collected from January 1, 2014 to December 31, 2016. RESULTS Out-of-hospital cardiac arrest occurred in 90 of 9855 patients diagnosed with myocardial infarction. We identified 2 significant risk factors: renal failure (HR, 6.53; 95% CI, 1.17-36.40; P = 0.03) and time (hours) from symptom onset to first medical contact (HR, 1.04; 95% CI, 1.01-1.08; P = 0.02). The probability of survival in patients below 66 years of age was almost 2-fold higher (HR, 1.99; 95% CI, 1.1-3.59; P = 0.02) than in those over the age of 66 years. In those without diabetes mellitus, it was more than 2-fold higher (HR, 2.36; 95% CI, 1.12-4.98; P = 0.03) than in diabetic patients, and in individuals with single-vessel coronary artery disease, it was almost 3-fold higher (HR, 2.76; 95% CI, 1.51-5.06; P = 0.001) than in those with multivessel coronary artery disease. CONCLUSIONS Well-documented predictors of all- cause mortality include: age, history of diabetes mellitus and renal failure, multivessel coronary artery disease on angiography, and time from pain onset to first medical contact. The total amount of contrast agent administered during invasive procedures and patient radiation exposure during procedures are less commonly reported risk factors for unfavorable outcomes.