Clinical paperPost-resuscitation electrocardiograms, acute coronary findings and in-hospital prognosis of survivors of out-of-hospital cardiac arrest☆
Introduction
Sudden out-of-hospital cardiac arrest (OHCA) is a common clinical problem with a very high mortality.1, 2, 3 Coronary artery disease and acute coronary syndromes are leading causes of OHCA.2, 3, 4 Therefore, identification of acute culprit lesions amenable to urgent percutaneous coronary intervention (PCI) in the setting of OHCA is crucial. Decision to perform emergent coronary angiography (ECA) is classically taken on the basis of ECG findings after recovery of spontaneous circulation.5 However, clinical and electrocardiographic data before angiography have inconsistent value for selecting patients for ECA.2, 6 Besides, the utility of performing ECA and PCI to all survivors of OHCA is controversial, especially in the subgroup of patients without ST-segment elevation on the post-resuscitation electrocardiogram.7, 8 The need for triage is justified not only by the fact that not all OHCA patients benefit from ECA9 but also by the limited availability, the cost and the potential complications of the technique.8, 10 In the present study, we analyzed the clinical characteristics, the post-resuscitation electrocardiograms and the acute angiographic findings of a series of consecutive OHCA patients who underwent ECA. Such information would be important for better selection of OHCA patients for ECA after successful resuscitation. We also analyzed hospital management, PCI results and in-hospital prognosis in this series.
Section snippets
Study design and patients
This retrospective study was conducted in a tertiary care referral center with catheterization laboratory capabilities that provides 24-h service. The study population consisted of all consecutive patients aged ≥18 years with sustained recovery of spontaneous circulation after OHCA who underwent ECA at our institution from January 2005 to December 2012. Decision for ECA was made by an acute cardiac care physician and an interventional cardiologist. Patients with an obvious non-ischemic cause of
Baseline characteristics
We retrospectively analyzed our internal database of 167 consecutive OHCA patients admitted to our institution from January 2005 to December 2012. We excluded from the analysis 2 patients without available post-resuscitation ECG traces, 49 patients with an obvious non-ischemic cause of OHCA, and 32 patients who did not undergo ECA because of the presence of significant co-morbidities before cardiac arrest or for perceived futility (Fig. 1). Finally, our study population comprised 84 patients,
Discussion
Our study confirms that patients presenting with STECG after aborted OHCA have a high prevalence of obstructive coronary artery disease, and a major proportion have culprit lesions suitable for emergency PCI. These findings are similar to those of previous studies in which an acute coronary occlusion has been found in 68–88% of OCHA patients presenting with STECG.4, 9, 13 We found that half of the NSTECG patients had obstructive coronary artery disease and 20% of cases had presumed acute
Conclusions
The presence of ST-segment elevation on the post-resuscitation ECG is strongly associated with the presence of an acute coronary occlusion, and is a useful criterion for selecting patients for emergency coronary angiography, especially in combination with other clinical and electrocardiographic criteria. Despite potential logistical difficulties, randomized trials should be performed to clarify the benefit of emergency coronary angiography in this population with a very high mortality rate.
Conflict of interest statement
None declared.
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2021, ResuscitationCitation Excerpt :Area under the ROC curve was 0.87 (95% CI 0.83-0.89) (Figs. 2 and 3). In total, 24 studies (n = 156,060 subjects) reported STE for attempted revascularization (Table 5).15,19,21–25,27–30,32–36,42 –44,47,51,54,56,59 Ultimately, 4 studies (n = 2,161 subjects) without critical risk of bias were included in meta-analyses with prevalence of attempted revascularization ranging from 28-92% (mean 54% [SD 15%]).27,28,32,51
Post resuscitation electrocardiogram for coronary angiography indication after out-of-hospital cardiac arrest
2020, International Journal of CardiologyCitation Excerpt :Out-of-hospital cardiac arrest (OHCA) is a leading cause of death and remains a meaningful issue in clinical cardiology, emergency medicine, and public health due to a very low survival rate of 20 to 30% [1–6].
Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest: A registry study
2019, ResuscitationCitation Excerpt :The focus on post-resuscitation care, including coronary angiography (CAG) and percutaneous coronary intervention (PCI) may have contributed to the increased survival after OHCA seen in recent decades. Up to 96% of patients referred for CAG with ST-elevation on ECG after return of spontaneous circulation (ROSC) have at least one significant coronary lesion.3,4 Several registry and observational studies have shown that CAG may improve outcome after OHCA.5–7
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.06.001.