Coronary artery disease
Angiographic Characteristics of Coronary Disease and Postresuscitation Electrocardiograms in Patients With Aborted Cardiac Arrest Outside a Hospital

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Postresuscitation electrocardiogram (ECG) in patients with aborted cardiac death may demonstrate ST-elevation myocardial infarction (STEMI), ST-T changes, intraventricular conduction delay, or other nonspecific findings. In the present study, we compared ECG to urgent coronary angiogram in 158 consecutive patients with STEMI and 54 patients not fulfilling criteria for STEMI admitted to our hospital from January 1, 2003 through December 31, 2008. At least 1 obstructive lesion was present in 97% of patients with STEMI and in 59% of patients without STEMI with ≥1 occlusion in 82% and 39%, respectively (p <0.001). Obstructive lesion was considered acute in 89% of patients with STEMI and in 24% of patients without STEMI (p <0.001). An acute lesion in STEMI had a higher thrombus score (2.6 vs 1.3, p = 0.05) and more often presented with Thrombolysis In Myocardial Infarction grade 0 to 1 flow (75% vs 36%, p <0.01). Percutaneous coronary intervention, which was attempted in 148 lesions in patients with STEMI and in 17 lesions in patients without STEMI, resulted in final Thrombolysis In Myocardial Infarction grade 3 flow in 87% and 71%, respectively (p = 0.34). In conclusion, STEMI on postresuscitation ECG is usually associated with the presence of an acute culprit lesion. However, in the absence of STEMI, an acute culprit lesion is still present in 1/4 of patients. An acute lesion in STEMI is more thrombotic and more often leads to complete occlusion. Urgent percutaneous coronary intervention is feasible and successful regardless of postresuscitation ECG.

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Methods

This retrospective study was performed at University Medical Center, Ljubljana and complied with the Declaration of Helsinki. The research protocol was approved by the Slovenian national ethics committee. Consecutive patients with out-of-hospital cardiac arrest of presumed cardiac origin and re-establishment of spontaneous circulation (ROSC) in the field who underwent urgent coronary angiography from January 1, 2003 through December 31, 2008 were investigated. Decision for urgent coronary

Results

During the study period 335 consecutive patients who had been resuscitated after out-of-hospital cardiac arrest were admitted (Figure 2). Because of exclusion criteria 158 of 179 patients with STEMI (88%) and 54 of 156 patients with non-STEMI (35%) underwent urgent coronary angiography. The 2 groups were comparable in general characteristics except for a greater incidence of previous coronary disease in patients without STEMI who had also a longer interval from collapse to advanced life support

Discussion

Our study confirmed the high incidence of obstructive coronary artery disease and the presence of ≥1 coronary occlusion in patients with aborted sudden cardiac death.1, 2, 5, 10, 11, 12 Because STEMI on postresuscitation ECG was associated with the presence of a presumed acute culprit lesion in almost 90% of cases, false-positive findings were uncommon. However, an acute lesion was found also in 24% in the absence of STEMI, which argues for an urgent invasive coronary strategy in this subgroup.

Acknowledgment

The authors recognize the significant contributions of the interventional cardiology group of the department of cardiology (Matjaz Bunc, MD, PhD, Marko Gricar, MD, Igor Kranjec, MD, PhD, Matjaz Sinkovec, MD, PhD, Radovan Starc, MD, PhD, Bojan Vrtovec, MD, PhD, Darko Zorman, MD, and Igor Zupan, MD, PhD) and intensive care physicians from the Center for Intensive Internal Medicine (Anja Jazbec, MD, Vojka Gorjup, MD, PhD, Matej Podbregar, MD, PhD, Ivo Radan, MD, Dusan Stajer, MD, PhD, and Simona

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This work was supported by Grant P3-0331 from the Slovenian Research Agency, Ljubljana, Slovenia.

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