TCT-519 Impact of Immediate Coronary Angiography on In-Hospital and Intermediate-Term Survival in Patients With Out-of-Hospital Cardiac Arrest and No ST-Segment Elevation: Updated Meta-Analysis

Background: Emerging data have supported a strategy of earlier access to cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA). However, there are as yet no randomized controlled trials (RCT) addressing the issue, and the impact of percutaneous coronary intervention (PCI) on outcome is unclear in the absence of STEMI. We report here the characteristics and outcomes of patients with OHCA without STEMI undergoing coronary angiography (CA) with PCI vs. no PCI, in contrast to patients not undergoing CA. Methods: Single center, retrospective study of 195 patients with OHCA without STEMI between July 2007 and April 2014. Patients were categorized into CA vs. no CA (control), and among those undergoing CA we compared those treated with PCI vs. no PCI. Mortality was assessed along with key relevant clinical and angiographic variables in each group (Table). Results: 195 cases with OHCA without STEMI were reviewed, among which 102 (52%) did not undergo CA. 93 (48%) patients underwent CA, of which 21 (23%) underwent PCI, whereas 72 (77%) did not require PCI. Acute culprit lesion was identified in only 19 out of 93 (20.4%) Inpatient mortality was similar in those undergoing PCI vs. no PCI (19% vs. 14%, p=0.56). Patients that did not undergo CA had a significantly worse mortality, in comparison to patients undergoing CA (p<0.001). Conclusions: In this series of consecutive patients with OHCA without STEMI, culprit lesions were uncommon when CA was performed. Overall outcomes in patients receiving CA were better than in those not receiving CA, likely reflecting referral bias based on disease severity. However, successful PCI in patients with obstructive CAD and culprit lesions was not associated with improved inpatient survival. These findings emphasize the need for RCTs to guide the need for CA and/or PCI in these patients.

Download Full-text

Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation

Circulation ◽

10.1161/circulationaha.120.049569 ◽

2020 ◽

Vol 142 (21) ◽

pp. 2002-2012 ◽

Cited By ~ 1

Author(s):

Karl B. Kern ◽

Peter Radsel ◽

Jacob C. Jentzer ◽

David B. Seder ◽

Kwan S. Lee ◽

...

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Adverse Events ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Efficacy And Safety ◽

St Segment Elevation ◽

End Point ◽

St Segment ◽

Hospital Cardiac Arrest

Background: The benefit of emergency coronary angiography after resuscitation from out-of-hospital cardiac arrest is uncertain for patients without ST-segment elevation. The aim of this randomized trial was to evaluate the efficacy and safety of early coronary angiography and to determine the prevalence of acute coronary occlusion in resuscitated patients with out-of-hospital cardiac arrest without ST-segment elevation. Methods: Adult (>18 years) comatose survivors without ST-segment elevation after resuscitation from out-of-hospital cardiac arrest were prospectively randomized in a 1:1 fashion under exception to informed consent regulations to early coronary angiography versus no early coronary angiography in this multicenter study. Early angiography was defined as ≤120 minutes from arrival at the percutaneous coronary intervention–capable facility. The primary end point was a composite of efficacy and safety measures, including efficacy measures of survival to discharge, favorable neurologic status at discharge (Cerebral Performance Category score ≤2), echocardiographic measures of left ventricular ejection fraction >50%, and a normal regional wall motion score of 16 within 24 hours of admission. Adverse events included rearrest, pulmonary edema on chest x-ray, acute renal dysfunction, bleeding requiring transfusion or intervention, hypotension (systolic arterial pressure ≤90 mm Hg), and pneumonia. Secondary end points included the incidence of culprit vessels with acute occlusion. Results: The study was terminated prematurely before enrolling the target number of patients. A total of 99 patients were enrolled from 2015 to 2018, including 75 with initially shockable rhythms. Forty-nine patients were randomized to early coronary angiography. The primary end point of efficacy and safety was not different between the 2 groups (55.1% versus 46.0%; P =0.64). Early coronary angiography was not associated with any significant increase in survival (55.1% versus 48.0%; P =0.55) or adverse events (26.5% versus 26.0%; P =1.00). Early coronary angiography revealed a culprit vessel in 47%, with a total of 14% of patients undergoing early coronary angiography having an acutely occluded culprit coronary artery. Conclusions: This underpowered study, when considered together with previous clinical trials, does not support early coronary angiography for comatose survivors of cardiac arrest without ST elevation. Whether early detection of occluded potential culprit arteries leads to interventions that improve outcomes requires additional study. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02387398.

Download Full-text

The role of coronary angiography in out-of-hospital cardiac arrest patients in the absence of ST-segment elevation: A literature review

Netherlands Heart Journal ◽

10.1007/s12471-020-01460-8 ◽

2020 ◽

Vol 28 (S1) ◽

pp. 108-114

Author(s):

E. M. Spoormans ◽

J. S. Lemkes ◽

G. N. Janssens ◽

N. W. van der Hoeven ◽

J. L. Bonnes ◽

...

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Literature Review ◽

St Segment Elevation ◽

St Segment ◽

Hospital Cardiac Arrest

Download Full-text

COMPARISON OF EARLY VERSUS DELAYED CORONARY ANGIOGRAPHY IN OUT-OF-HOSPITAL CARDIAC ARREST WITHOUT ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31982-3 ◽

2020 ◽

Vol 75 (11) ◽

pp. 1355

Author(s):

Muhammad Khalid ◽

Ghulam Murtaza ◽

Muhammad Talha Ayub ◽

Varun Kohli ◽

Rajesh Sachdeva ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Arrest ◽

Coronary Angiography ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Hospital Cardiac Arrest

Download Full-text

Impact of urgent coronary angiography on mid-term clinical outcome of comatose out-of-hospital cardiac arrest survivors presenting without ST-segment elevation

Resuscitation ◽

10.1016/j.resuscitation.2015.06.022 ◽

2015 ◽

Vol 94 ◽

pp. 61-66 ◽

Cited By ~ 16

Author(s):

Martin Kleissner ◽

Marek Sramko ◽

Jan Kohoutek ◽

Josef Kautzner ◽

Jiri Kettner

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Clinical Outcome ◽

St Segment Elevation ◽

St Segment ◽

Hospital Cardiac Arrest

Download Full-text

Abstract 10989: Diagnostic Impact Of Electrocardiogram And Emergency Coronary Angiography In Patients With Out-of-hospital-cardiac-arrest

Circulation ◽

10.1161/circ.132.suppl_3.10989 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Kazuya Tateishi ◽

Daisuke Abe ◽

Toru Iwama ◽

Tatsuro Sassa ◽

Kouichi Oohashi ◽

...

Keyword(s):

Cardiac Arrest ◽

Angina Pectoris ◽

Coronary Angiography ◽

Vasospastic Angina ◽

St Segment Elevation ◽

Coronary Lesion ◽

St Segment ◽

Number Of Patients ◽

Vasospastic Angina Pectoris ◽

Hospital Cardiac Arrest

Objective: The guideline suggests that coronary angiography (CAG) should be performed for the patients with out-of-hospital-cardiac-arrest (OHCA) and return of spontaneous cardiac arrest (ROSC). We investigated the association between initial ST-segment change after ROSC and incidence of acute coronary lesion in patients with OHCA. We also researched the number of patients with OHCA caused by vasospastic angina pectoris (VSA). Methods: From April 2011 to March 2015, there were 2,779 OHCA patients in our institution. We underwent CAG for all patients with ROSC, except for obvious extra-cardiac cause of OHCA. Initial ST-segment change after ROSC of serial 155 patients(61±14.5years old,83.9% male) was reviewed. Results: The 34% of patients had ST-segment elevation and the 66% had other electrocardiogram (ECG) pattern. Significant coronary lesion which needs percutaneous coronary intervention (PCI) was shown in the 81% of patients with ST-segment elevation and in 33% with other ECG (P<0.001). ST-segment analysis had a good positive predictive value (81%) but a low negative value (68%) in diagnosing the presence of acute coronary lesions. The patients who were diagnosed vasospastic angina were found in the 10% of patients with ST-segment elevation and in the 12% with other ECG. Conclusion: Even in the absence of ST-segment elevation, acute culprit coronary lesion may be present, and there is significant value to perform emergency CAG for ROSC patients. Furthermore, vasospastic angina pectoris may be present and considered the trigger of cardiac arrest. Emergency CAG could remove the coronary artery spasm by directly NO injection.

Download Full-text