Association Between the Timing of Coronary Angiography, Targeted Temperature Management, and Neurological Outcomes After Out-of-Hospital Cardiac Arrest: A Nationwide Population-Based Registry Study in Korea

BACKGROUND: Coronary angiography (CAG) and targeted temperature management (TTM) may improve clinical outcomes after out-of-hospital cardiac arrest. This study aimed to assess whether the intervention effects differed according to timing and percutaneous coronary intervention (PCI) performance. METHODS AND RESULTS: Adult patients with presumed cardiac cause who underwent CAG and TTM within 24 hours following out-of-hospital cardiac arrest were included from the Korean nationwide out-of-hospital cardiac arrest registry. We investigated the associations between the timing of interventions and whether CAG was performed before TTM initiation (CAG-first) and good neurological outcomes. Intervention times were divided into 4 quartiles, and odds ratios (ORs) were calculated with the fourth quartile as the reference. A total of 844 patients were enrolled. CAG and TTM were initiated a median of 2.4 hours (interquartile range [IQR], 1.8–3.2) and 4.3 hours (IQR, 3.2–6.0) after OHCA, respectively. Univariable analysis revealed associations between the earliest intervention groups and good neurological outcomes. However, after adjustment, neither the intervention time nor intervention prioritization was associated with good outcomes. The first quartile of CAG time (<1.8 hours) was associated with good outcomes in the subgroup with PCI (n=570) (adjusted OR [aOR], 1.93 [95% CI, 1.10–3.40]). In the subgroup without PCI (n=274), early TTM initiation (<3.2 hours) and CAG-first were significantly associated with outcomes (aOR, 3.08 [95% CI, 1.36–6.96]; aOR, 0.44 [95% CI, 0.20–0.97]; respectively). CONCLUSIONS: Neither intervention time nor intervention prioritization was associated with good outcomes. However, early CAG and TTM independently predicted good outcomes in the subgroups with PCI and without PCI, respectively.