P3243Prognostic impact of physical activity just before out-of-hospital cardiac arrest due to myocardial ischemia

Abstract

Background: It was reported that coronary artery disease (CAD) is one of the major cause of exercise related cardiac arrest. We investigated the association between the finding from coronary images and physical activity just before out-ofhospital cardiac arrest (OHCA) due to myocardial ischemia. And we also investigated whether cardiac arrest (CA) under strong load affects the prognosis. Methods: From 2006 to 2016, consecutive 281 patients with OHCA due to myocardial ischemia underwent coronary angiography (CAG). After excluding 63 patients with vasospastic angina, the remaining 218 patients with CAD were enrolled in this study. We estimated maximum metabolic equivalent (METS) intensities within 5 minutes just before CA occurred. We divided the patients into three groups according to their maximum physical activity just before CA: vigorous activity group (VG, n=34; 85% patients during sports), comprising patients with METS≥6.0 (8.5±2.3METS), the intermediate activity group (IG, n=67), comprising patients with 2.0≤METS<6.0 (2.9±0.8METS) and the light activity group (LG, n=117), comprising patients with METS<2.0 (1.3±0.1METS). We analyzed clinical outcome, which was defined as survival with good neurological outcome at 30 days. Results: Incidence of AED usage (VG vs. IG vs. LG; 74% vs. 45% vs. 37%) and the primary shockable rhythm (97% vs. 76% vs. 74%) were highest in VG group than in other 2 groups. The time from collapse to cardiopulmonary resuscitation (1.0±1.7 vs. 3.0±4.3 vs. 3.4±5.6min) and from collapse to return of spontaneous circulation (11.4±9.8 vs. 23.7±16.7 vs. 32.0±26.0min) was shortest in VG group (all p<0.05). There were significant differences in incidence of ST-segment elevation among 3 groups (15% vs. 64% vs. 69%: p<0.001). The finding of culprit lesion on arrival resulted significant differences among 3 groups (good collateral and/or TIMI3 flow: 82% vs. 22% vs. 21%, CAG and/or intravascular ultrasound (IVUS) findings of plaque rupture or thrombus: 9% vs. 82% vs. 93%, all p<0.001). According to ROC curve analysis, the optimal cut-off point of physical activity for the plaque rupture was 5.8METs (sensitivity of 0.61 and specificity of 0.98), and the area under the curve was 0.85 (95% CI: 0.78-0.91; P<0.001). Kaplan-Meier curve showed VG was best neurological outcome at 30-days compared with other 2 groups (p<0.0001, log-rank test) (Figure). Multivariable analysis revealed that independent predictors of 30-days neurological outcome were maximum METS just before CA (OR: 0.71, 95% CI: 0.52-0.98, p=0.036) and the time from collapse to cardiopulmonary resuscitation (OR: 1.31, 95% CI: 1.14-1.50, p<0.001). Conclusions: Ischemia due to plaque rupture and coronary thrombosis is not responsible for cardiac arrest during high METS activity. Cardiac arrest during high METS activity might provide better clinical outcome.