Immediate versus early coronary angiography with targeted temperature management in out-of-hospital cardiac arrest survivors without ST-segment elevation: A propensity score-matched analysis from a multicenter registry

Resuscitation ◽  
2019 ◽  
Vol 135 ◽  
pp. 30-36 ◽  
Author(s):  
Youn-Jung Kim ◽  
Yong Hwan Kim ◽  
Byung Kook Lee ◽  
Yoo Seok Park ◽  
Min Seob Sim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Propensity Score ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
St Segment Elevation ◽  
St Segment ◽  
Hospital Cardiac Arrest ◽  
Multicenter Registry

Effects of Targeted Temperature Management in Patients with Post-Cardiac Arrest Syndrome after an Out-Of-Hospital Cardiac Arrest Caused by Hanging: A Prospective Observational Cohort Study in Japan

2021 ◽  
Author(s):  
Ryuichiro Kakizaki ◽  
Naofumi Bunya ◽  
Shuji Uemura ◽  
Takehiko Kasai ◽  
Keigo Sawamoto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Propensity Score ◽  
Multivariate Logistic Regression Analysis ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Matched Cohort ◽  
Neurological Outcomes ◽  
Post Cardiac Arrest Syndrome ◽  
Hospital Cardiac Arrest

Abstract Background: Targeted temperature management (TTM) is recommended for unconscious patients after a cardiac arrest. However, its effectiveness in patients with post-cardiac arrest syndrome (PCAS) by hanging remains unclear. Therefore, this study aimed to investigate the relationship between TTM and favorable neurological outcomes in patients with PCAS by hanging.Methods: This study was a retrospective analysis of the Japanese Association for Acute Medicine out-of-hospital cardiac arrest (OHCA) registry between June 2014 and December 2017 among patients with PCAS admitted to the hospitals after an OHCA caused by hanging. A multivariate logistic regression analysis was performed to estimate the propensity score and to predict whether patients with PCAS by hanging receive TTM. We compared patients with PCAS by hanging who received TTM (TTM group) and those who did not (non-TTM group) using propensity score analysis.Results: A total of 199 patients with PCAS by hanging were enrolled in this study. Among them, 43 were assigned to the TTM group and 156 to the non-TTM group. Logistic regression model adjusted for propensity score revealed that TTM was not associated with favorable neurological outcome at 1-month (adjusted odds ratio [OR]: 1.38, 95% confidence interval [CI]: 0.27–6.96). Moreover, no difference was observed in the propensity score-matched cohort (adjusted OR: 0, 73, 95% CI: 0.10–4.71) and in the inverse probability of treatment weighting-matched cohort (adjusted OR: 0.63, 95% CI: 0.15–2.69).Conclusions: TTM was not associated with increased favorable neurological outcomes at 1-month in patients with PCAS after OHCA by hanging.

Abstract 18207: Role of Coronary Angiography with Successful Percutaneous Coronary Intervention in Patients with Out-of-Hospital Cardiac Arrest without ST-Segment Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yader Sandoval ◽  
David F Miranda ◽  
Steven R Goldsmith ◽  
Bradley A Bart ◽  
Stephen W Smith ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Impact ◽  
Referral Bias ◽  
Hospital Cardiac Arrest

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.

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

Circulation ◽  
2020 ◽  
Vol 142 (21) ◽  
pp. 2002-2012 ◽  
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.

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

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

scholarly journals Early Identification of Resuscitated Patients with a Significant Coronary Disease in Out-of-Hospital Cardiac Arrest Survivors without ST-Segment Elevation

2021 ◽  
Vol 10 (23) ◽  
pp. 5688
Author(s):  
Chun-Song Youn ◽  
Hahn Yi ◽  
Youn-Jung Kim ◽  
Hwan Song ◽  
Namkug Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Significant Coronary Artery Disease ◽  
Coronary Artery Lesion ◽  
Temperature Management ◽  
Multicenter Observational Study ◽  
St Segment Elevation ◽  
St Segment ◽  
Resuscitated Patients ◽  
Hospital Cardiac Arrest

This study aimed to develop a machine learning (ML)-based model for identifying patients who had a significant coronary artery disease among out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE). This multicenter observational study used data from the Korean Hypothermia Network prospective registry (KORHN-PRO) gathered between October 2015 and December 2018. We used information available before targeted temperature management (TTM) as predictor variables, and the primary outcome was a significant coronary artery lesion in coronary angiography (CAG). Among 1373 OHCA patients treated with TTM, 331 patients without STE who underwent CAG were enrolled. Among them, 127 patients (38.4%) had a significant coronary artery lesion. Four ML algorithms, namely regularized logistic regression (RLR), random forest classifier (RF), CatBoost classifier (CBC), and voting classifier (VC), were used with data collected before CAG. The VC model showed the highest accuracy for predicting significant lesions (area under the curve of 0.751). Eight variables (older age, male, initial shockable rhythm, shorter total collapse duration, higher glucose and creatinine, and lower pH and lactate) were significant to ML models. These results showed that ML models may be useful in developing early predictive tools for identifying high-risk patients with a significant stenosis in CAG.

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

Circulation ◽  
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.

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