AIMS: To describe the use of emergency coronary angiography (CAG) and primary percutaneous coronary intervention (PCI) and the association with short- and long-term survival in consecutive comatose survivors after out-of-hospital cardiac arrest (OHCA). METHODS: In the period 2004-10, a total of 479 consecutive patients with OHCA of suspected cardiac cause were referred to a tertiary cardiac centre, 360 patients were comatose and admitted to the ICU for post-resuscitative care. The population was stratified in two groups according to the pattern of the first ECG obtained after re-established circulation; ST-segment elevation (STEMI, n=116) and ECG without STEMI pattern (No-STEMI, n=244). Emergency CAG (≤12 hours after OHCA) was performed at the discretion of the attending cardiologist. Primary outcome was 30-day and 1-year survival. RESULTS: Emergency CAG was performed in all patients in the STEMI group compared to 82 (34%) in the group without STEMI pattern (p<0.0001) with significant coronary lesions found in 108 (93%) compared to 43 (52%) patients, respectively (p<0.0001). Survival at 30 day according to emergency CAG vs. no emergency CAG was 65% in the STEMI group compared to 66% and 54% in the group without STEMI pattern (p log-rank=0.11). The use of emergency CAG in the group without STEMI pattern was not associated with reduced mortality (HRadjusted=0.69, 95% CI 0.4-1.2, p=0.18). CONCLUSIONS: In comatose survivors of OHCA presenting with STEMI, a high prevalence of coronary disease and culprit lesions suitable for emergency PCI was found, whereas in patients without STEMI pattern, significant coronary stenosis was less frequent. Clinical benefits of emergency CAG/PCI in comatose survivors of OHCA presenting without STEMI could not be identified.
AIMS: To describe the use of emergency coronary angiography (CAG) and primary percutaneous coronary intervention (PCI) and the association with short- and long-term survival in consecutive comatose survivors after out-of-hospital cardiac arrest (OHCA). METHODS: In the period 2004-10, a total of 479 consecutive patients with OHCA of suspected cardiac cause were referred to a tertiary cardiac centre, 360 patients were comatose and admitted to the ICU for post-resuscitative care. The population was stratified in two groups according to the pattern of the first ECG obtained after re-established circulation; ST-segment elevation (STEMI, n=116) and ECG without STEMI pattern (No-STEMI, n=244). Emergency CAG (≤12 hours after OHCA) was performed at the discretion of the attending cardiologist. Primary outcome was 30-day and 1-year survival. RESULTS: Emergency CAG was performed in all patients in the STEMI group compared to 82 (34%) in the group without STEMI pattern (p<0.0001) with significant coronary lesions found in 108 (93%) compared to 43 (52%) patients, respectively (p<0.0001). Survival at 30 day according to emergency CAG vs. no emergency CAG was 65% in the STEMI group compared to 66% and 54% in the group without STEMI pattern (p log-rank=0.11). The use of emergency CAG in the group without STEMI pattern was not associated with reduced mortality (HRadjusted=0.69, 95% CI 0.4-1.2, p=0.18). CONCLUSIONS: In comatose survivors of OHCA presenting with STEMI, a high prevalence of coronary disease and culprit lesions suitable for emergency PCI was found, whereas in patients without STEMI pattern, significant coronary stenosis was less frequent. Clinical benefits of emergency CAG/PCI in comatose survivors of OHCA presenting without STEMI could not be identified.
Authors: R O Cummins; D A Chamberlain; N S Abramson; M Allen; P Baskett; L Becker; L Bossaert; H Delooz; W Dick; M Eisenberg Journal: Ann Emerg Med Date: 1991-08 Impact factor: 5.721
Authors: Stefan Zimmermann; Frank A Flachskampf; Anna Alff; Reinhard Schneider; Katharina Dechant; Lutz Klinghammer; Christian Stumpf; Yurdaguel Zopf; Thomas Loehr; Georg Brand; Josef Ludwig; Werner G Daniel; Stephan Achenbach Journal: Int J Cardiol Date: 2011-12-26 Impact factor: 4.164
Authors: J S Hochman; L A Sleeper; J G Webb; T A Sanborn; H D White; J D Talley; C E Buller; A K Jacobs; J N Slater; J Col; S M McKinlay; T H LeJemtel Journal: N Engl J Med Date: 1999-08-26 Impact factor: 91.245
Authors: Zacharias Alexandros Anyfantakis; Gabriel Baron; Pierre Aubry; Dominique Himbert; Laurent J Feldman; Jean-Michel Juliard; Agnès Ricard-Hibon; Alexis Burnod; Dennis V Cokkinos; Philippe Gabriel Steg Journal: Am Heart J Date: 2008-11-06 Impact factor: 4.749
Authors: John Bro-Jeppesen; Jesper Kjaergaard; Tina I Horsted; Michael C Wanscher; Søren Louman Nielsen; Lars S Rasmussen; Christian Hassager Journal: Resuscitation Date: 2008-12-25 Impact factor: 5.262
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: Clifton W Callaway; Michael W Donnino; Ericka L Fink; Romergryko G Geocadin; Eyal Golan; Karl B Kern; Marion Leary; William J Meurer; Mary Ann Peberdy; Trevonne M Thompson; Janice L Zimmerman Journal: Circulation Date: 2015-11-03 Impact factor: 29.690
Authors: Xue-Han Ning; Outi M Villet; Ming Ge; Laigam N Sekhar; Marshall A Corson; Tracy S Tylee; Lu-Ping Fan; Lin Yao; Chun Zhu; Aaron K Olson; Norman E Buroker; Cheng-Su Xu; David L Anderson; Yong-Kian Soh; Elise Wang; Shi-Han Chen; Michael A Portman Journal: Ther Hypothermia Temp Manag Date: 2014-12-16 Impact factor: 1.286