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.
References (25)
Optimal treatment of patients surviving out-of-hospital cardiac arrest
J Am Coll Cardiol: Cardiovasc Interv
(2012)- et al.
Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest
Resuscitation
(2007) - et al.
Acute coronary angiographic findings in survivors of out-of-hospital cardiac arrest
Am Heart J
(2009) - et al.
Advanced life support 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Advanced Life Support Chapter Collaborators
Resuscitation
(2010) - et al.
Value of post-resuscitation electrocardiogram in the diagnosis of acute myocardial infarction in out-of-hospital cardiac arrest patients
Resuscitation
(2011) - et al.
Angiographic characteristics of coronary disease and postresuscitation electrocardiograms in patients with aborted cardiac arrest outside a hospital
Am J Cardiol
(2011) - et al.
Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital cardiac arrest
Resuscitation
(2013) - et al.
Impact of emergency coronary angiography on in-hospital outcome of unconscious survivors after out-of-hospital cardiac arrest
Am J Cardiol
(2012) - et al.
Acute ST-elevation myocardial infarction after successful cardiopulmonary resuscitation
Resuscitation
(2007) Should we use postresuscitation ECG to decide for immediate invasive coronary strategy after resuscitated cardiac arrest?
Resuscitation
(2013)
Acute coronary angiography in patients resuscitated from out-of-hospital cardiac arrest – a systematic review and meta-analysis
Resuscitation
Comparison of clinical characteristics and outcomes of cardiac arrest survivors having versus not having coronary angiography
Am J Cardiol
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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.