Elsevier

Resuscitation

Volume 90, May 2015, Pages 13-20
Resuscitation

Clinical Paper
Angiographic findings and survival in patients undergoing coronary angiography due to sudden cardiac arrest in Western Sweden

https://doi.org/10.1016/j.resuscitation.2014.11.034Get rights and content

Abstract

Aim

Sudden cardiac arrest (SCA) accounts for more than half of all deaths from coronary heart disease. Time to return of spontaneous circulation is the most important determinant of outcome but successful resuscitation also requires percutaneous coronary intervention in selected patients. However, proper selection of patients is difficult. We describe data on angiographic finding and survival from a prospectively followed SCA patient cohort.

Methods

We merged the RIKS-HIA registry (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) and SCAAR (Swedish Coronary Angiography and Angioplasty Registry) for patients hospitalized in cardiac care units in Western Sweden between January 2005 and March 2013. We performed propensity score-adjusted logistic and Cox proportional-hazards regression analyses on complete-case data as well as on imputed data sets.

Results

638 consecutive patients underwent coronary angiography due to SCA. Severity of coronary artery disease was similar among SCA patients and patients undergoing coronary angiography due to suspected coronary artery disease (n = 37,142). An acute occlusion was reported in the majority of SCA patients and was present in 37% of patients who did not have ST-elevation on the post resuscitation ECG. 31% of SCA patients died within 30 days. Long-term risk of death among patients who survived the first 30 days was higher in patients with SCA compared to patients with acute coronary syndromes (P < 0.001).

Conclusions

Coronary artery disease and acute coronary occlusions are common among patients who undergo coronary angiography after sudden cardiac arrest. These patients have a substantial mortality risk both short- and long-term.

Introduction

Sudden cardiac arrest (SCA) carries a dismal prognosis and accounts for more than half of all deaths from coronary heart disease. Overall survival ranges between 3 and 10% depending on initial recorded rhythm, underlying cause, patient characteristics, and time to cardiopulmonary resuscitation and/or defibrillation.1, 2, 3, 4, 5

Time to return of spontaneous circulation (ROSC) is the most important determinant of outcome. International guidelines and algorithms have been established and are being continuously advanced to ensure rapid ROSC.6, 7 However, successful resuscitation requires more than ROSC and recent studies have recognized and focused on appropriate post-resuscitation treatment. In selected patients, prevention of hyperthermia and/or timely coronary angiography followed, if indicated, by percutaneous coronary intervention (PCI) have been shown to improve outcome.8, 9, 10, 11, 12, 13

European as well as American guidelines recommend urgent angiography in all patients with SCA where an acute coronary syndrome is suspected.6, 7 ST-segment elevation on post-resuscitation ECG has traditionally been used to select patients for intervention. However, there is evidence that post-resuscitation ECG alone is insufficient to decide which patients should be referred for urgent coronary angiography.14 These studies indicate that angiography is feasible in all patients after SCA in whom an obvious non-cardiac cause cannot be identified, regardless of findings on post-reperfusion ECG.15

In this study we present data on angiographic findings and survival from all consecutive patients who underwent coronary angiography due to SCA in Western Sweden and who were prospectively followed within RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) and SCAAR (Swedish Coronary Angiography and Angioplasty Registry) between 2005 and 2013.

Section snippets

Methods

We merged data from RIKS-HIA and SCAAR for patients hospitalized in cardiac care units in Västra Götaland County in Western Sweden between Jan 2005 and March 2013. All patients who underwent coronary angiography in the region during this period were included in the study. The patients were considered to have diabetes, hypertension, hyperlipidemia, previous MI, previous PCI, previous stroke, cardiogenic shock or heart failure based on the ICD codes documented in the registry.16 We plotted the

The SWEDEHEART registry

SCAAR and RIKS-HIA registries are two components of SWEDEHEART registry (Swedish Websystem for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). SCAAR contains information on consecutive patients from all 30 centers that perform PCI in Sweden, 5 of which are localized in Västra Götaland County. In SCAAR, a coronary angiography is described by approximately 50 variables whereas a PCI is described by approximately 200 variables. RIKS-HIA contains a

Patient's characteristics

638 patients with SCA underwent coronary angiography in Västra Götaland County between 2005 and 2013 (Fig. 1). This accounts for 1.7% of all patients who underwent angiography in the region during the study period (Fig. 2A). 451 patients (88%) suffered out-of-hospital SCA while 187 (12%) patients developed in-hospital SCA. Among the patients who suffered out-of-hospital SCA, 360 (80%) underwent coronary angiography on the admission day, 32 (7%) on the first day and 26 (6%) within three days of

Discussion

We investigated angiographic findings and long-term survival in 638 patients who underwent coronary angiography due to SCA in Western Sweden. We found that patients suffering from SCA present with a similar grade of coronary artery disease as patients with ACS and that SCA survivors have increased risk of death long after index hospitalization.

Our data show that angiographic findings in patients who undergo coronary angiography due to SCA are similar to patients who undergo coronary angiography

Conclusions

Coronary artery disease and acute coronary occlusions are common among patients who undergo coronary angiography after SCA. These patients have a substantially increased short-term and long-term mortality as compared with patients who undergo coronary angiography due to suspected ACS.

Conflict on interest statement

None of the authors has any relevant conflict of interest.

Acknowledgements

The study was supported by the Swedish Heart and Lung Foundation, the Swedish Scientific Research Council, AFA Insurance and the University of Gothenburg, Sweden.

References (24)

  • J.M. Field et al.

    Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

    Circulation

    (2010)
  • N. Nielsen et al.

    Targeted temperature management at 33 °C versus 36 °C after cardiac arrest

    N Engl J Med

    (2013)
  • Cited by (23)

    • 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 :

      No randomized studies were identified, and all included studies were observational cohorts. Altogether, 48 studies enrolled 160,032 subjects with CAG between 1994-2018 and were published between 1997-2020.14–61 There were 30 studies from Europe, 11 from North America, 5 from Asia, one from Oceana, and one from a trans-continental collaboration.

    • Impact of Coronary Artery Chronic Total Occlusion on Arrhythmic and Mortality Outcomes: A Systematic Review and Meta-Analysis

      2018, JACC: Clinical Electrophysiology
      Citation Excerpt :

      All 3 studies reported a significant increase in the risk of VT/VF or appropriate ICD therapy with a pooled multivariate HR of 1.99 (95% CI: 1.53 to 2.59; p < 0.0001; I2 = 3%) (Figure 2B). Moreover, 3 studies examined the relationship between CTO status and cardiac mortality (16,17,20) (Figures 2C and 2D). Our meta-analysis shows that the presence of CTO was associated with a significant increase in the risk of cardiac mortality (unadjusted HR: 3.90; 95% CI: 1.22 to 12.40; p < 0.05; I2 = 96%) (Figure 2C).

    • Coronary angiographic findings and outcomes in patients with sudden cardiac arrest without ST-elevation myocardial infarction: A SWEDEHEART study

      2018, Resuscitation
      Citation Excerpt :

      Post-resuscitation electrocardiogram (ECG) ST-elevation SCA (STE-SCA) is a strong indication for emergent coronary angiography [5]. However, ECG has been shown to be a poor predictor of acute occlusion as approximately one in three to one in four OHCA patients without ST-elevation have acute occlusions [8–16]. Moreover, acute angiography and PCI were associated with improved survival in some observational studies [8,11,16], however, other studies report conflicting outcome data [17,18].

    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.2014.11.034.

    View full text