Elsevier

Resuscitation

Volume 85, Issue 9, September 2014, Pages 1245-1250
Resuscitation

Clinical paper
Post-resuscitation electrocardiograms, acute coronary findings and in-hospital prognosis of survivors of out-of-hospital cardiac arrest

https://doi.org/10.1016/j.resuscitation.2014.06.001Get rights and content

Abstract

Background

Identification of acute coronary lesions amenable to urgent intervention in survivors of out-of-hospital cardiac arrest is crucial. We aimed to compare the clinical and electrocardiographic characteristics to urgent coronary findings, and to analyze in-hospital prognosis of these patients.

Methods

From January 2005 to December 2012 we retrospectively identified consecutive patients resuscitated from out-of-hospital cardiac arrest, and analyzed the clinical characteristics, post-resuscitation electrocardiogram and coronary angiogram of those who underwent emergent angiography. Mortality and neurologic status at discharge were also assessed.

Results

Patients with ST-elevation more frequently had obstructive coronary artery disease (89% vs. 51%, p < 0.001) or acute coronary occlusions (83% vs. 8%, p < 0.001) than patients without ST-elevation. Independent predictors of an acute coronary occlusion were chest pain before arrest (OR 0.16, 95% CI 0.04–0.7, p = 0.01), a shockable initial rhythm (OR 0.16, 95% CI 0.03–0.9, p = 0.03), and ST-elevation on the post-resuscitation electrocardiogram (OR 0.02, 95% CI 0.004–0.13, p < 0.001). Survival with favorable neurologic recovery at discharge was 59%. Independent predictors of mortality or unfavorable neurological outcome at discharge were absence of basic life support (OR 0.2, 95% CI 0.06–0.9, p = 0.04), prolonged resuscitation time (OR 0.9, 95% CI 0.8–0.9, p = 0.01), and necessity of vasopressors (OR 14.8, 95% CI 3.3–65.4, p = 0.001).

Conclusions

Most patients with ST-elevation on the post-resuscitation electrocardiogram had an acute coronary occlusion, as opposed to patients without ST-elevation. Absence of basic life support, prolonged resuscitation time and use of vasopressors were independent predictors of worse in-hospital outcome.

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)

Cited by (40)

  • Diagnostic test accuracy of the initial electrocardiogram after resuscitation from cardiac arrest to indicate invasive coronary angiographic findings and attempted revascularization: A systematic review and meta-analysis

    2021, Resuscitation
    Citation 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 Cardiology
    Citation 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, Resuscitation
    Citation 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

View all citing articles on Scopus

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.

View full text