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Timing and Outcomes after Coronary Angiography following Out-of-Hospital Cardiac Arrest without signs of STEMI

      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.

      OBJECTIVES

      We sought to describe the timing of post-arrest CAG in actual practice, patient characteristics associated with decision to perform immediate versus delayed CAG, and patient outcomes following CAG.

      METHODS

      We conducted a retrospective cohort study at seven U.S. academic hospitals. Resuscitated adult OHCA patients were included if they presented between 1/1/2015-12/31/2019 and recieved CAG during hospitalization. EMS 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 hours) and “delayed” (>6 hours).

      RESULTS

      221 patients were included. Median time to CAG was 18.6 (IQR:1.5-94.6) hours. Early catheterization was performed on 94 patients (42.5%) and delayed catheterization on 127 patients (57.5%). Patients in the early group were older (61 [IQR:55-70] vs. 57 [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.

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