Matthew Wilson1, Anne V Grossestreuer2, David F Gaieski3, Benjamin S Abella2, William Frohna4, Munish Goyal4. 1. Department of Emergency Medicine, Medstar Washington Hospital Center, Washington, DC 20010, United States; Georgetown University School of Medicine, Washington, DC 20008, United States. Electronic address: mdw12@medstar.net. 2. Department of Emergency Medicine and the Center for Resuscitation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States. 3. Sidney Kimmel Medical College, Jefferson University, Philadelphia, PA 19107, United States. 4. Department of Emergency Medicine, Medstar Washington Hospital Center, Washington, DC 20010, United States; Georgetown University School of Medicine, Washington, DC 20008, United States.
Abstract
OBJECTIVE: With the demonstrated benefit of an early-invasive strategy for STEMI and VF/VT arrest patients, there is interest in assessing the potential benefit of early angiography for non-shockable (PEA/Asystole) arrest patients. We hypothesized that in cardiac arrest patients who obtain return of spontaneous circulation (ROSC) after a non-shockable initial rhythm and do not have STEMI the incidence of coronary intervention would be clinically insignificant (<5%). METHODS: Retrospective multicenter US clinical registry study of post-cardiac arrest patients at 18 hospitals between 1/00 and 5/14. The incidence of significant coronary artery disease (CAD) as defined by documented coronary intervention (i.e. PCI, angioplasty, stent or CABG) was assessed. RESULTS: There were 1396 arrest patients with ROSC and known initial rhythms (517/1396=37% shockable; 879/1396=63% nonshockable). 440 (299/440=58% shockable; 141/440=32% nonshockable) of these patients received angiography. In the 141 non-shockable patients that received angiography, 97 patients did not have STEMI listed as an indication for catheterization and 24 (25%) of those had a coronary intervention documented yielding an observed incidence of coronary intervention in non-shockable post-arrest patients without STEMI who received angiography of 24.7% (24/97). Of note, the overall incidence of coronary intervention in all ROSC patients with non-shockable initial rhythms was 5.5% (48/879). CONCLUSIONS: In this large multi-center retrospective analysis there is a high incidence of coronary intervention in post-arrest patients with initially non-shockable rhythms and without STEMI on ECG who are taken for angiography.
OBJECTIVE: With the demonstrated benefit of an early-invasive strategy for STEMI and VF/VT arrestpatients, there is interest in assessing the potential benefit of early angiography for non-shockable (PEA/Asystole) arrestpatients. We hypothesized that in cardiac arrestpatients who obtain return of spontaneous circulation (ROSC) after a non-shockable initial rhythm and do not have STEMI the incidence of coronary intervention would be clinically insignificant (<5%). METHODS: Retrospective multicenter US clinical registry study of post-cardiac arrestpatients at 18 hospitals between 1/00 and 5/14. The incidence of significant coronary artery disease (CAD) as defined by documented coronary intervention (i.e. PCI, angioplasty, stent or CABG) was assessed. RESULTS: There were 1396 arrestpatients with ROSC and known initial rhythms (517/1396=37% shockable; 879/1396=63% nonshockable). 440 (299/440=58% shockable; 141/440=32% nonshockable) of these patients received angiography. In the 141 non-shockable patients that received angiography, 97 patients did not have STEMI listed as an indication for catheterization and 24 (25%) of those had a coronary intervention documented yielding an observed incidence of coronary intervention in non-shockable post-arrestpatients without STEMI who received angiography of 24.7% (24/97). Of note, the overall incidence of coronary intervention in all ROSC patients with non-shockable initial rhythms was 5.5% (48/879). CONCLUSIONS: In this large multi-center retrospective analysis there is a high incidence of coronary intervention in post-arrestpatients with initially non-shockable rhythms and without STEMI on ECG who are taken for angiography.
Authors: Sini Saarinen; Ari Salo; James Boyd; Päivi Laukkanen-Nevala; Catharina Silfvast; Ilkka Virkkunen; Tom Silfvast Journal: Scand J Trauma Resusc Emerg Med Date: 2018-11-19 Impact factor: 2.953