Outcomes of Out-of-Hospital Cardiac Arrest at Centers With and Without On-Site Coronary Angiography: A Nationwide Analysis.

Abstract

Background: The American Heart Association has advocated for regionalized systems of care for out-of-hospital cardiac arrest (OHCA), emphasizing admission to specialized centers with onsite coronary angiography. However, national data evaluating outcomes of OHCA admission to such centers remain limited.

Methods: Using the 2021 National Inpatient Sample, we identified all direct OHCA hospitalizations across US facilities. Hospitals were categorized as angio-capable if they performed ≥1 coronary angiography in 2021 (others: angio-incapable). The primary outcome was in-hospital mortality. Mixed-effects modeling quantified interhospital variation in mortality. Multivariable logistic regression modeling compared mortality between groups.

Results: Of 251 260 OHCA hospitalizations across 2867 centers, 92.6% occurred at angio-capable hospitals and 7.4% at angio-incapable facilities. Patients at angio-capable centers were younger, more frequently male, and had higher rates of ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, cardiogenic shock, and shockable rhythms. Crude mortality was higher at angio-incapable centers than at angio-capable facilities (83.0 versus 67.7%, P<0.001). After adjustment for patient characteristics, hospital-level factors accounted for 13.5% of mortality variation. Admission to angio-incapable centers was associated with 60% greater odds of death (adjusted odds ratio, 1.60 [95% CI, 1.42-1.80]). Marginal effects analysis demonstrated stepwise reduction in predicted mortality rate, from 87.0% (95% CI, 85.5-88.5) at rural angio-incapable centers to 67.3% (95% CI, 66.7-67.9) at urban angio-capable centers.

Conclusions: Admission to hospitals without coronary angiography is associated with higher mortality following OHCA, with the greatest risk observed in rural settings. These findings support regionalized systems of postarrest care and the role of coronary angiography-capable centers as resuscitation hubs.