Abstract
Background
There is broad consensus that resuscitated out-of-hospital cardiac arrest (OHCA) patients
with ST-segment elevation myocardial infarction (STEMI) should receive immediate coronary
angiography (CAG); however, factors that guide patient selection and optimal timing
of CAG for post-arrest patients without evidence of STEMI remain incompletely described.
Objective
We sought to describe the timing of post-arrest CAG in actual practice, patient characteristics
associated with decision to perform immediate vs. delayed CAG, and patient outcomes
after CAG.
Methods
We conducted a retrospective cohort study at seven U.S. academic hospitals. Resuscitated
adult patients with OHCA were included if they presented between January 1, 2015 and
December 31, 2019 and received CAG during hospitalization. Emergency medical services
run sheets and hospital records were analyzed. Patients without evidence of STEMI
were grouped and compared based on time from arrival to CAG performance into “early”
(≤ 6 h) and “delayed” (> 6 h).
Results
Two hundred twenty-one patients were included. Median time to CAG was 18.6 h (interquartile
range [IQR] 1.5–94.6 h). Early catheterization was performed on 94 patients (42.5%)
and delayed catheterization was performed on 127 patients (57.5%). Patients in the
early group were older (61 years [IQR 55–70 years] vs. 57 years [IQR 47–65] years)
and more likely to be male (79.8% vs. 59.8%). Those in the early group were more likely
to have clinically significant lesions (58.5% vs. 39.4%) and receive revascularization
(41.5% vs. 19.7%). Patients were more likely to die in the early group (47.9% vs.
33.1%). Among survivors, there was no significant difference in neurologic recovery
at discharge.
Conclusions
OHCA patients without evidence of STEMI who received early CAG were older and more
likely to be male. This group was more likely to have intervenable lesions and receive
revascularization.
Keywords
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REFERENCES
- Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest.N Engl J Med. 2015; 372: 2307-2315
- Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.Circ Cardiovasc Qual Outcomes. 2010; 3: 63-68
- Trends and outcomes of coronary angiography and percutaneous coronary intervention after out-of-hospital cardiac arrest associated with ventricular fibrillation or pulseless ventricular tachycardia.JAMA Cardiol. 2016; 1: 890-899
- Emergent percutaneous coronary intervention for resuscitated victims of out-of-hospital cardiac arrest.Catheter Cardiovasc Interv. 2010; 75: 616-624
- Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.N Engl J Med. 1997; 336: 1629-1633
- Clinical factors associated with significant coronary lesions following out-of-hospital cardiac arrest.Acad Emerg Med. 2022; 29: 456-464
- Initial clinical predictors of significant coronary lesions after resuscitation from cardiac arrest.Ther Hypothermia Temp Manag. 2012; 2: 73-77
- 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 61: e78-140
- 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.Eur Heart J. 2018; 39: 119-177
- European resuscitation council guidelines for resuscitation 2015: Section 1. executive summary.Resuscitation. 2015; 95: 1-80
- Value of post-resuscitation electrocardiogram in the diagnosis of acute myocardial infarction in out-of-hospital cardiac arrest patients.Resuscitation. 2011; 82: 1148-1153
- Acute coronary angiographic findings in survivors of out-of-hospital cardiac arrest.Am Heart J. 2009; 157: 312-318
- Association of timing of electrocardiogram acquisition after return of spontaneous circulation with coronary angiography findings in patients with out-of-hospital cardiac arrest.JAMA Network Open. 2021; 4e2032875https://doi.org/10.1001/jamanetworkopen.2020.32875
- The evolving role of the cardiac catheterization laboratory in the management of patients with out-of-hospital cardiac arrest: a scientific statement from the American Heart Association.Circulation. 2019; 139: e530-e552
- INTCAR-Cardiology Registry. Outcomes of comatose cardiac arrest survivors with and without ST-segment elevation myocardial infarction: importance of coronary angiography.JACC Cardiovasc Interv. 2015; 8: 1031-1040
- Acute coronary angiography in patients resuscitated from out-of-hospital cardiac arrest: a systematic review and meta-analysis.Resuscitation. 2012; 83: 1427-1433
- Coronary angiography after cardiac arrest without ST-segment elevation.N Engl J Med. 2019; 380: 1397-1407
- Coronary angiography after cardiac arrest without ST segment elevation: one-year outcomes of the COACT randomized clinical trial.JAMA Cardiol. 2020; 5: 1358-1365
- Coronary angiography after cardiac arrest—the right timing or the right patients?.N Engl J Med. 2019; 380: 1474-1475
- Angiography after out-of-hospital cardiac arrest without ST-segment elevation.N Engl J Med. 2021; 385: 2544-2553
- What percent luminal stenosis should be used to define angiographic coronary artery disease for noninvasive test evaluation?.Ann Noninvasive Electrocardiol. 2002; 7: 98-105
- Relationship between baseline coronary calcium score and demonstration of coronary artery stenoses during follow-up MESA (Multi-Ethnic Study of Atherosclerosis).JACC Cardiovasc Imaging. 2009; 2: 1175-1183
- Association of timing of electrocardiogram acquisition after return of spontaneous circulation with coronary angiography findings in patients with out- of-hospital cardiac arrest.JAMA Netw Open. 2021; 4e2032875
- Timing of coronary angiography in survivors of out-of-hospital cardiac arrest without obvious extracardiac causes.Resuscitation. 2018; 123: 98-104
- Early versus delayed invasive intervention in acute coronary syndromes.N Engl J Med. 2009; 360: 2165-2175
- Early versus standard care invasive examination and treatment of patients with non-ST-segment elevation acute coronary syndrome verdict randomized controlled trial.Circulation. 2018; 138: 2741-2750
- Optimal timing of invasive angiography in stable non-ST-elevation myocardial infarction: the Leipzig Immediate versus early and late PercutaneouS coronary Intervention triAl in NSTEMI (LIPSIA-NSTEMI Trial).Eur Heart J. 2012; 33: 2035-2043
- Coronary angiography after cardiac arrest: rationale and design of the COACT trial.Am Heart J. 2016; 180: 39-45
- The Health Insurance Portability and Accountability Act of 1996. Pub L 104-191.Stat. 2014; : 1936
- Research electronic data capture (REDCap)–A metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- REDCap Consortium. The REDCap consortium: building an international community of software partners.J Biomed Inform. 2019; 95103208
- Emergency percutaneous coronary intervention in post-cardiac arrest patients without ST-segment elevation pattern: insights from the PROCAT II Registry.JACC Cardiovasc Interv. 2016; 9: 1011-1018
- Pulseless electrical activity and unsuccessful out-of-hospital resuscitation: what is the cause of death?.Resuscitation. 2008; 77: 207-210
- Coronary lesions in refractory out of hospital cardiac arrest (OHCA) treated by extra corporeal pulmonary resuscitation (ECPR).Resuscitation. 2018; 126: 154-159
- Early coronary angiography and survival after out-of-hospital cardiac arrest.Circ Cardiovasc Interv. 2015; 8e002321
- Acute coronary syndromes: differences in men and women.Curr Atheroscler Rep. 2016; 18: 73
- Gender disparities in patients with out-of-hospital cardiac arrest in the absence of ST-segment elevation: a substudy of the COACT Trial.J Am Coll Cardiol. 2020; 75: 235
Article info
Publication history
Published online: January 21, 2023
Accepted:
January 6,
2023
Received in revised form:
December 15,
2022
Received:
September 6,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
