Angiographic Characteristics of Coronary Disease and Postresuscitation Electrocardiograms in Patients with Aborted Cardiac Arrest Outside a Hospital

After cardiac arrest, post-resuscitation electrocardiogram (ECG) may demonstrate ST- elevation myocardial infarction (STEMI), ST changes, or other findings concerning for coronary artery occlusion. In this retrospective study, researchers at an academic medical center in Slovenia examined the ECGs of 212 consecutive patients who underwent percutaneous coronary angiography (PCA) after out-of-hospital cardiac arrest, seeking to relate the ECG to a culprit lesion. Three hundred thirty-five patients with out-of-hospital cardiac arrest over a 5-year period were initially examined in the study, with 123 being excluded from PCA due to death before angiography, patients being post-coronary artery bypass grafting, non-ischemic cause of arrest, prolonged down time, physician decision, or other excluding criteria. Of the remaining 212, 158 demonstrated STEMI on ECG and 54 had no evidence of STEMI on ECG, but all underwent PCA. Obstructive coronary disease as demonstrated by PCA was present in 97% of patients with STEMI, of which 89% were presumed acute lesions. Obstructive lesions were present in 59% of patients with no STEMI on ECG, with 24% presumed acute. The authors use these results to advocate PCA in certain patient populations with evidence of STEMI on ECG, as well as patients without evidence of STEMI on ECG after out-of-hospital cardiac arrest.