• Resuscitation · Apr 2019

    Aortic stenosis is an independent predictor for outcome in patients with in-hospital cardiac arrest.

    • Patrick Sulzgruber, Sebastian Schnaubelt, Marco Pesce, Thomas Uray, Jan Niederdöckl, Hans Domanovits, Raphael Rosenhek, Thomas Binder, Klaus Distelmaier, Christian Hengstenberg, Alexander Niessner, and Georg Goliasch.
    • Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
    • Resuscitation. 2019 Apr 1; 137: 156-160.

    BackgroundPrognostic tools for decision-making whether to continue advanced life support or limit life sustaining interventions in In-Hospital Cardiac Arrest (IHCA), remain scarce and inconclusive. In this regard it seems intuitive that the presence of aortic stenosis (AS) impacts on both central and peripheral perfusion during resuscitative attempts and might worsen outcome. Therefore, we aimed to investigate the prognostic value of AS on outcome after IHCA.MethodsOut of 11,641 patients presenting with acute coronary syndrome, a total of 151 patients were identified that received a standardized echocardiographic diagnostic immediately prior to an IHCA. Binary logistic regression analysis was used to elucidate the prognostic impact of AS on outcome.ResultsWithin the entire study population, a total of 51 individuals with AS (mild: n = 19 [12.5%]; moderate: n = 11 [7.2%]; severe: n = 21 [13.8%]) were identified. We observed that 81% of patients with severe AS did not survive until hospital discharge. Additionally, the presence of AS showed a strong and independent inverse association with return of spontaneous circulation (adjusted odds ratio [OR] of 0.10 [95%CI:0.03-0.36], p < 0.001), survival (adj. OR of 0.14 [95%CI: 0.04-0.48]; p = 0.002) and favourable neurological outcome (OR of 0.16 [95%CI: 0.06-0.49]; p = 0.001). The observed prognostic impact remained stable irrespective of AS severity.ConclusionAS proved to be a strong and independent predictor for mortality and poor outcome after IHCA. Therefore, the presence of AS mirrors an easily available predictive tool for risk stratification and decision-making.Copyright © 2019 Elsevier B.V. All rights reserved.

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