scholarly journals Complete Revascularisation is associated with Improved Survival after Out of Hospital Cardiac Arrest

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Kanyal ◽  
N Pareek ◽  
D Sarma ◽  
A Bharucha ◽  
R Dworakowski ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Final Analysis ◽  
Syntax Score ◽  
Group A ◽  
Artery Disease ◽  
Complete Revascularisation ◽  
Group B ◽  
Hospital Cardiac Arrest

Abstract Introduction Coronary artery disease (CAD) is common in patients with Out of Hospital Cardiac Arrest (OOHCA) but the clinical relevance of burden of CAD and evidence for revascularisation strategies in relation to outcomes and modes of death remains unclear. Purpose This study sought to assess the extent of CAD as defined by the SYNTAX score and prognostic value of complete compared with incomplete revascularisation by evaluating the SYNTAX revascularisation index (SRI) in patients with OOHCA. Methods 619 patients with OOHCA were admitted at our centre between 1st May 2012 and 31st December 2017. 237 were excluded for having a non-cardiac aetiology or prior neurological disability. 398 patients were included into the study and of these 272 (68.3%) had early coronary angiography (CAG) and were included in the final analysis. The baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) were determined from the coronary angiograms by a cardiologist blinded to the outcome. Patients were subdivided into 4 subgroups according to quartiles of the baseline syntax score (bSS) of 0, Group A: 1–10, Group B: 11–20 and Group C: ≥21. Complete revascularisation (CR) was defined as SRI of 1 and incomplete (IR) as SRI <1 where the SRI=(1-[rSS/bSS]) ×100 (Figure 1). Results Patients with a bSS of 0 were younger, had less shockable initial arrest rhythms and worse lactate and pH on arrival.Patients with bSS>0 (i.e., those with coronary artery disease) had similar cardiac arrest circumstances in terms of rates of witnessed, bystander CPR and shockable rhythms. Admission metabolic status reflected by pH and lactate and rates of ST elevation/LBBB were also identical for all three groups. However, LVEF on admission decreased significantly as coronary complexity increased (P<0.0001). While early angiography was more preferentially performed in those with higher coronary complexity, paradoxically, those with bSS 1–4 had highest rates of culprit lesions which was reflected in higher rates of PCI (Figure 1). 124 (45.4%) had CR compared with 54.2% with IR. CR was most likely to be achieved as the coronary complexity reduced (Group A – 71.7%, Group B – 41.1%, Group C - 23.3%). There was no difference in rates of cardiogenic shock between both groups (CR 61.1% vs. IR 69% p=ns), but patients with complete revascularisation were younger (58.8 vs 67.8, p<0.0001), lower rates of hypertension and previous CABG (16.2% vs 3.2%, p≤0.0001) CR was associated with decreased mortality at 30 days (45.9% vs 34.6%, p=0.046) and 12 months (49.3% vs 35.4%, p=0.022). The lower mortality rate in CR appeared to partly be driven by lower cardiac deaths though this was not statistically significant (22% vs 7%, p=0.1) (Figure 2). Conclusions CR in a primary coronary aetiology OOHCA group is associated with reduced early and long-term mortality, which may be driven by a reduction in cardiac deaths. Prospective randomised trials in this population are warranted. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Infarct-related chronic total coronary occlusion and the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors

2021 ◽  
Author(s):  
M. van der Graaf ◽  
L. S. D. Jewbali ◽  
J. S. Lemkes ◽  
E. M. Spoormans ◽  
M. van der Ent ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Coronary Occlusion ◽  
Independent Factor ◽  
St Segment Elevation ◽  
St Segment ◽  
Artery Disease ◽  
Chronic Total Coronary Occlusion ◽  
Hospital Cardiac Arrest

Abstract Introduction Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. Methods We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. Results A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2–35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. Conclusion In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event.

scholarly journals Effect of empiric antiarrhythmic therapy in resuscitated out-of-hospital cardiac arrest victims with coronary artery disease

1990 ◽  
Vol 65 (18) ◽  
pp. 1192-1197 ◽  
Author(s):  
Ali R. Moosvi ◽  
Sidney Goldstein ◽  
Sharon VanderBrug Medendorp ◽  
J.Richard Landis ◽  
Robert A. Wolfe ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Antiarrhythmic Therapy ◽  
Artery Disease ◽  
Hospital Cardiac Arrest

scholarly journals Relationship between Hemoglobin A1c Level and Severity of Coronary Artery Disease Among The Hospitalized Patients with Acute Coronary Syndrome

2018 ◽  
Vol 33 (2) ◽  
pp. 80-84
Author(s):  
Syed Dawood Md Taimur ◽  
Sahela Nasrin ◽  
M Maksumul Haq ◽  
MA Rashid ◽  
Hemanta I Gomes ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Hemoglobin A1c ◽  
Diabetic Patients ◽  
Age Group ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Group A ◽  
Artery Disease ◽  
Group B

Background : Diabetes mellitus is one of the important risk factors for coronary artery disease. The hemoglobin A1c is used for evaluating glycemic control in diabetic patients. Here, we conducted the study to evaluate the relationship between HbA1c level and severity of coronary artery disease among the hospitalized patients with ACS. Materials & Methods : This cross sectional study was conducted in the department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from September 2015 to December 2015. Total of one hundred patients were studied and they were grouped on the basis of their glycaemic status. One hundred patients with acute coronary syndrome were enrolled in this study. Out of them fifty were diabetic (HbA1c>6.5%) and rest of were nondiabetics (HbA1c<6.5%) ( group-A and B). Results: Out of one hundred patients fifty eight were male and fourty two were female. Mean age of patients in group-A was 58.54±10.22 years and mean age of patients in group-B was 54.52±13.69 years. Mean age of male and female was 57.72±11.48 years and 54.0±13.08 years respectively. Mean HbA1c of patients in group-A was 11.43±1.43% and group-B was 6.34±0.915%. 38% of group-A and 22% of group-B had triple vessel disease, 26% of group-A and 20% of group- B had double vessel disease and 28% of group-A and 18% of group-B had single vessel disease, and 8% of group-A and 40% of group-B had normal coronary arteries. 48% patients of age group 46-50 in group-A had more incidence in coronary artery disease than other age group which was statistically significant ( p=0.035). 61-75 years age group in group-B patients had coronary artery disease than other age groups which was statistically not significant(p=0.084). Patients of group-A was significantly relation with coronary artery disease (p>.001) and six times greater coronary artery disease than patients of group-B (OR= 6.15, 95% CI for OR =2.074 -18.289). Conclusions: In this way the importance of appropriate glycaemic control has been emphasized in diabetic patients. This study showed the relation between HbA1c levels and the severity of CAD in patient with type-II diabetes mellitus .Our findings demonstrate that elevated HbA1c level was risk factor for severity of coronary artery disease in ACS patients. Bangladesh Heart Journal 2018; 33(2) : 80-84

DOES ST DEPRESSION HELP PREDICT CORONARY ARTERY DISEASE AFTER AN OUT-OF-HOSPITAL CARDIAC ARREST?

2017 ◽  
Vol 33 (10) ◽  
pp. S133
Author(s):  
C. Cheung ◽  
D. Wan ◽  
B. Grunau ◽  
C. Taylor ◽  
M. Deyell ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
St Depression ◽  
Artery Disease ◽  
Hospital Cardiac Arrest

scholarly journals Intra-Femoral Sheath Time: Does it Increase a Patient's Risk for Developing a Hematoma?

2013 ◽  
Author(s):  
Colleen Planchon
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Femoral Artery ◽  
Percutaneous Coronary Interventions ◽  
Medication Therapy ◽  
Coronary Interventions ◽  
Percutaneous Coronary ◽  
Group A ◽  
Artery Disease ◽  
Group B

Despite advancements in technology and medication therapy, coronary artery disease continues to remain the number one cause of death. Treatment for coronary artery disease requires life style modifications, medication therapy, percutaneous coronary interventions, and sometimes coronary artery bypass surgery. Though percutaneous coronary interventions are considered safe and are commonly occurring procedures, there are still risks for complications. One of the most frequently occurring complications is hematoma of the femoral artery site. The purpose of this study was to determine if there was an increased incidence of hematomas in individuals undergoing percutaneous coronary intervention with associated sheath times of less than five hours (Group A) as compared to sheath time of greater than five hours (Group B). The study used a retrospective, two group design and was conducted at a tertiary care center that performs over 1500 PCI’s annually. Inclusion criteria included adults over the age of 18 who were hemodynamically stable, had no known bleeding disorders, and were punctured once at the femoral artery to perform the percutaneous intervention. Two hundred fifty medical records were reviewed utilizing a data collection tool designed by the researcher. Total sample size was 55, 21 in Group A and 34 in Group B. Six hematomas were documented as occurring, but were not reportable based on the ACC definition. Hematomas were documented in the medical record using the terms “small”, “medium,” and “large” versus an objective measurement. No hematomas were identified using the ACC definition, which was the measurement standard for this research hospital. Sheath times in Group A averaged 4.02 hours, and group B 7.42 hours. There was a higher incidence of descriptive hematoma that did not meet the criteria of this study in Group B. Results call for recommendations of on-going documentation of post procedure hematomas using a standardized, reliable, and valid measuring tool. APRN’s can be instrumental in implementing change in patient care , hospital policy and on the national level by assuring that hematomas are accurately and consistently documented. Further research is indicated related to sheath times and potential associated negative outcomes.

scholarly journals Subclinical Hypothyroidism with TSH>7 mIU/l and≤10 mIU/l and Coronary Artery Disease

2020 ◽  
Vol 52 (02) ◽  
pp. 85-88
Author(s):  
Pedro Weslley Souza Rosário ◽  
Maria Regina Calsolari
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Subclinical Hypothyroidism ◽  
Calcium Score ◽  
Thyroid Stimulating Hormone ◽  
Group A ◽  
Artery Disease ◽  
Group B ◽  
Low Cardiovascular Risk

AbstractThe association of subclinical hypothyroidism (SCH) with increased cardiovascular risk is controversial when thyroid-stimulating hormone (TSH) concentration is<10 mIU/l, as well as its association with a higher coronary artery calcium score (CACS) in individuals with low cardiovascular risk. This study evaluated coronary artery disease (CAD) by CACS in asymptomatic, low-cardiovascular risk women with SCH and TSH>7 mIU/l and≤10 mIU/l untreated for 5 years after diagnosis. The CACS was obtained for two groups of women with low cardiovascular risk. Group A consisted of 32 women with mild SCH (TSH>7 mIU/l and≤10 mIU/l) who remained untreated for 5 years, and group B consisted of 32 euthyroid women matched for age and body mass index to group A. The CACS ranged from 0 to 350 (median 0, 25–75% interval: 0–10) in group A and from 0 to 280 (median 0, 25–75% interval: 0–0) in group B. Scores>0 and≥10 were significantly more frequent in group A (40.6 vs. 12.5% and 25 vs. 3.1%, respectively). A CACS≥100 was also more frequent in group A (18.75 vs. 3.1%), but the difference was not significant (p=0.1). The results of the study suggest that long-term SCH with TSH>7 mIU/l and ≤ 10 mIU/l is associated with a higher risk of CAD in individuals≤65 years, even in those with low cardiovascular risk.

6031Out -of-hospital cardiac arrest - incidence of coronary artery disease, co-morbidity and survival

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Soeholm ◽  
C Hassager ◽  
F Pedersen ◽  
U Abildgaard ◽  
S Haahr-Pedersen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Prognostic Factors ◽  
Coronary Artery ◽  
Urban Region ◽  
Coronary Syndrome ◽  
Total Cohort ◽  
Artery Disease ◽  
Hospital Cardiac Arrest

Abstract Background Data from the European Cardiovascular Disease Statistics from 2012 shows that 20% of all deaths are caused by coronary artery disease with cardiac arrest (CA) as the most common scenario. Historic data have shown that coronary artery disease was present in approximately 70% of unselected out-of-hospital CA (OHCA) patients byangiography. As registry and retrospective data are prone to bias it remains unknown whether an early invasive strategy translates into improved outcome, we present our experience from a large urban region of Denmark. Purpose The aim was to describe a consecutive OHCA-cohort with regards to incidence of coronary artery disease, comorbidity and survival rate. Methods A consecutive unselected cohort of patients with OHCA in the Capital Region of Denmark was included (n=1,003) from 2007 to 2011. After successful resuscitation patients were admitted for post-resuscitation care at 1 of 8 hospitals including coronary angiography and percutaneous coronary interventions (PCI) when indicated. Results Patients were 65±15 years old, 71% were male, 52% had shockable primary rhythm, median time to return of spontaneous circulation (ROSC) was 22 minutes (Q1–Q3: 13–37 min), the majority was unconscious at hospital admission (89%), and no previous comorbidity was noted in 52%. The majority of the cohort had OHCA due to a cardiac cause (n=806, 80%). Acute coronary syndrome (ACS) was diagnosed in 39% of the total cohort (n=389), and in 48% of patients with cardiac cause with ST-segment elevation myocardial infarction being more frequent (n=236, 60% of ACS). 30-day mortality was 59% in the total cohort and 46% in patients with ACS (plogrank<0.001). A favourable neurological outcome (Cerebral Performance Category 1 or 2) was noted in 84% of all patients discharged alive (n=347), and in 85% of patients with ACS (n=178). In the total cohort ACS was independently associated with a lower 30-day mortality rate (hazard ratio (HR) = 0.62, 95% confidence interval (CI) 0.51–0.75, p<0.001) after adjustment for age, pre-hospital OHCA circumstances (bystander CPR, public arrest and witnessed arrest), time to ROSC, primary admission to a tertiary heart centre, and degree of comorbidity. In OHCA-patients with ACS only, successful PCI was independently associated with a lower 30-day mortality after adjustment for the mentioned prognostic factors (HR all ACS= 0.46, 95% CI 0.31–0.67, p<0.001, HR STEMI= 0.43, 0.27–0.69, p<0.001, HR NSTEMI= 0.12, 0.03–0.51, p=0.004). Conclusion In an unselected clinical cohort of out-of-hospital cardiac arrest survivors less than half of the patients was diagnosed with acute coronary syndrome. ACS was associated with a better prognosis even after adjustment for prognostic factors. Successful PCI was likewise an independent prognostic factor, however this may be due to selection bias and a direct support of acute angiography in all OHCA-survivors should await the results of randomised clinical trials. Acknowledgement/Funding Trygfonden

scholarly journals Predictors of In-Hospital Mortality after Recovered Out-of-Hospital Cardiac Arrest in Patients with Proven Significant Coronary Artery Disease: A Retrospective Study

2020 ◽  
Vol 6 (1) ◽  
pp. 41-51
Author(s):  
Maria Trepa ◽  
Samuel Bastos ◽  
Marta Fontes-Oliveira ◽  
Ricardo Costa ◽  
André Dias-Frias ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Retrospective Study ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Significant Coronary Artery Disease ◽  
Artery Disease ◽  
Hospital Cardiac Arrest

AbstractIntroductionRecovered Out-of-Hospital Cardiac Arrest (rOHCA) population is heterogenous. Few studies focused on outcomes in the rOHCA subgroup with proven significant coronary artery disease (SigCAD). We aimed to characterize this subgroup and study the determinants of in-hospital mortality.MethodsRetrospective study of consecutive rOHCA patients submitted to coronary angiography. Only patients with SigCAD were included.Results60 patients were studied, 85% were male, mean age was 62.6 ± 12.1 years. In-hospital mortality rate was 43.3%. Patients with diabetes and history of stroke were less likely to survive. Significant univariate predictors of in-hospital mortality were further analysed separately, according to whether they were present at hospital admission or developed during hospital evolution. At hospital admission, initial non-shockable rhythm, low-flow time>12min, pH<7.25mmol/L and lactates >4.75mmol/L were the most relevant predictors and therefore included in a score tested by Kaplan-Meyer. Patients who had 0/4 criteria had 100% chance of survival till hospital discharge, 1/4 had 77%, 2/4 had 50%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. During in-hospital evolution, a pH<7.35 at 24h, lactates>2mmol/L at 24h, anoxic brain injury and persistent hemodynamic instability proved significant. Patients who had 0/4 of these in-hospital criteria had 100% chance of survival till hospital discharge, 1/4 had 94%, 2/4 had 47%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. Contrarily, CAD severity and ventricular dysfunction didn’t significantly correlate to the outcome.ConclusionClassic prehospital variables retain their value in predicting mortality in the specific group of OHCA with SigCAD. In-hospital evolution variables proved to add value in mortality prediction. Combining these simple variables in risk scores might help refining prognostic prediction in these patients’s subset.

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