BACKGROUND: Diagnosis of acute coronary artery disease in survivors of out-of-hospital cardiac arrest (OHCA) is difficult. The role of emergency coronary angiography and percutaneous coronary intervention (PCI) in this setting is debated. The objective of this study was to assess the prevalence of coronary lesions on emergency angiography in survivors of OHCA. METHODS: Seventy-two consecutive OHCA survivors underwent systematic emergency coronary angiography. Patients with critical stenoses or occlusion underwent ad hoc PCI. RESULTS: Most (63.9%) OHCA survivors had angiographic coronary artery disease (> or =1 lesion >50%), but only a minority (37.5%) had clinical or angiographic evidence of an acute coronary syndrome due to either an acute occlusion (16.7%) or an irregular lesion suggestive of ruptured plaque or thrombus (25.0%). A final diagnosis of myocardial infarction was assigned in 27 patients (37.5%). Percutaneous coronary intervention was attempted and successful in 33.3% of the total cohort (n = 24). Hospital survival was 48.6%. By multivariable analysis, use of PCI was not an independent correlate of survival. ST-segment elevation on admission was an independent correlate of acute myocardial infarction (odds ratio 64.2, 95% CI 7.6-544.2, P = .0001), with high positive (82.6%) and negative (83.7%) predictive values. CONCLUSIONS: A minority of OHCA patients has angiographic evidence of an acute coronary syndrome and one-third undergo PCI, but PCI is not an independent correlate of survival. The presence of ST elevation on admission was a strong independent correlate of acute myocardial infarction and may be used to triage OHCA patients to emergency angiography with a view to PCI.
BACKGROUND: Diagnosis of acute coronary artery disease in survivors of out-of-hospital cardiac arrest (OHCA) is difficult. The role of emergency coronary angiography and percutaneous coronary intervention (PCI) in this setting is debated. The objective of this study was to assess the prevalence of coronary lesions on emergency angiography in survivors of OHCA. METHODS: Seventy-two consecutive OHCA survivors underwent systematic emergency coronary angiography. Patients with critical stenoses or occlusion underwent ad hoc PCI. RESULTS: Most (63.9%) OHCA survivors had angiographic coronary artery disease (> or =1 lesion >50%), but only a minority (37.5%) had clinical or angiographic evidence of an acute coronary syndrome due to either an acute occlusion (16.7%) or an irregular lesion suggestive of ruptured plaque or thrombus (25.0%). A final diagnosis of myocardial infarction was assigned in 27 patients (37.5%). Percutaneous coronary intervention was attempted and successful in 33.3% of the total cohort (n = 24). Hospital survival was 48.6%. By multivariable analysis, use of PCI was not an independent correlate of survival. ST-segment elevation on admission was an independent correlate of acute myocardial infarction (odds ratio 64.2, 95% CI 7.6-544.2, P = .0001), with high positive (82.6%) and negative (83.7%) predictive values. CONCLUSIONS: A minority of OHCA patients has angiographic evidence of an acute coronary syndrome and one-third undergo PCI, but PCI is not an independent correlate of survival. The presence of ST elevation on admission was a strong independent correlate of acute myocardial infarction and may be used to triage OHCA patients to emergency angiography with a view to PCI.
Authors: J Dankiewicz; N Nielsen; M Annborn; T Cronberg; D Erlinge; Y Gasche; C Hassager; J Kjaergaard; T Pellis; H Friberg Journal: Intensive Care Med Date: 2015-03-24 Impact factor: 17.440
Authors: Ralf Koester; Jan Kaehler; Achim Barmeyer; Kai Müllerleile; Marion Priefler; Gerold Soeffker; Stephan Braune; Axel Nierhaus; Thomas Meinertz; Stefan Kluge Journal: Clin Res Cardiol Date: 2011-06-21 Impact factor: 5.460
Authors: Clifton W Callaway; Robert Schmicker; Mitch Kampmeyer; Judy Powell; Tom D Rea; Mohamud R Daya; Thomas P Aufderheide; Daniel P Davis; Jon C Rittenberger; Ahamed H Idris; Graham Nichol Journal: Resuscitation Date: 2010-01-13 Impact factor: 5.262
Authors: José Luis Ferreiro; José Carlos Sánchez-Salado; Montserrat Gracida; Ana Lucrecia Marcano; Gerard Roura; Albert Ariza; Josep Gómez-Lara; Victoria Lorente; Rafael Romaguera; Sílvia Homs; Guillermo Sánchez-Elvira; Luis Teruel; Kristian Rivera; Silvia Gabriela Sosa; Joan Antoni Gómez-Hospital; Dominick J Angiolillo; Angel Cequier Journal: J Cardiovasc Transl Res Date: 2013-12-21 Impact factor: 4.132
Authors: John Bro-Jeppesen; Jesper Kjaergaard; Michael Wanscher; Frants Pedersen; Lene Holmvang; Freddy K Lippert; Jacob E Møller; Lars Køber; Christian Hassager Journal: Eur Heart J Acute Cardiovasc Care Date: 2012-12