Abstract 15738: New Left Bundle Branch Block (LBBB) as a Predictor of Coronary Occlusion After Out-of-Hospital Cardiac Arrest (OHCA)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Lindsey Kowalski ◽  
Jacob Jentzer ◽  
James Fitzgibbon ◽  
Michael Scutella ◽  
Clifton Callaway ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Sensitivity And Specificity ◽  
Coronary Occlusion ◽  
New Left ◽  
Current Standard ◽  
Acute Coronary Occlusion ◽  
Cast Doubt ◽  
St Elevation ◽  
Few Data

Introduction: In the setting of recent cardiac arrest, it is controversial whether new LBBB with or without Sgarbossa Criteria is an ST elevation (STE) equivalent for predicting acute coronary occlusions. The 2010 AHA guidelines recommend urgent coronary angiography after OHCA when either STE or new LBBB is present. These guidelines are extrapolated from the non-arrest population with few data from OHCA patients. Hypothesis: New LBBB on EKG early after OHCA will have a weaker association with acute coronary occlusion than STE. Methods: This was a retrospective 2 center study of 284 OHCA subjects who underwent early coronary angiography (within 24 hours of resuscitation). The post-resuscitation EKG was reviewed by a study investigator (LK) with cardiology over reading (JJ). Subjects with either STE or new LBBB were identified. Cardiologists performed percutaneous intervention (PCI) at their discretion when a culprit lesion or acute thrombus was found. We calculated the sensitivity and specificity for STE, LBBB, and STE + LBBB (current standard) for predicting PCI and the odds ratio (OR) and 95% confidence intervals (CI) for the association between these EKG findings and PCI. OR were calculated relative to subjects with no STE or LBBB. Results: Of the 284 patients, 125 presented with STE and 19 presented with new LBBB resulting in 144 patients meeting AHA criteria for angiography. None of the LBBB met Sgarbossa Criteria. PCI was performed in 95/125 (76%) of those with STE, 4/19 (21%) of those with LBBB and 99/144 (69%) with either finding. The sensitivity and specificity of STE for PCI were 62% and 77% and the unadjusted OR was 5.82 (95% CI: 3.45, 9.83; p < 0.001). The sensitivity and specificity of ST elevation or new LBBB for PCI was 65% and 66% (OR =3.72 [95% CI: 2.28, 6.09; p < 0.001]). New LBBB was inversely associated with PCI (OR = 0.21 [95% CI: 0.07, 0.66; p = 0.0075]. Survival was higher in those who underwent PCI with STE (OR 8.23 [95% CI: 3.31, 20.48; p <0.0001]) but not in those with LBBB (OR of 0.60 [95% CI: 0.09, 4.01; p=0.5950]). Conclusions: Our findings confirm STE after OHCA is strongly associated with coronary occlusion amenable to PCI, but cast doubt on using new LBBB as an STE equivalent. These findings mirror recent reports about LBBB in non-OHCA patients.

scholarly journals Troponin Marker for Acute Coronary Occlusion and Patient Outcome Following Cardiac Arrest

2015 ◽  
Vol 16 (7) ◽  
pp. 1007-1013 ◽  
Author(s):  
David Pearson ◽  
Catherine Wares ◽  
Katherine Mayer ◽  
Michael Runyon ◽  
Jonathan Studnek ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Cardiac Arrest ◽  
Coronary Occlusion ◽  
Acute Coronary Occlusion

scholarly journals Acute coronary occlusion during coronary angiography in two cases. Treatment by transluminal disobliteration.

Heart ◽  
1982 ◽  
Vol 47 (3) ◽  
pp. 244-248 ◽  
Author(s):  
A Cribier ◽  
J Berland ◽  
G Brunhes ◽  
C Richard ◽  
B Letac
Keyword(s):  
Coronary Angiography ◽  
Coronary Occlusion ◽  
Acute Coronary Occlusion

Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG—Short- and long-term survival

2018 ◽  
Vol 200 ◽  
pp. 90-95 ◽  
Author(s):  
Ludvig Elfwén ◽  
Rickard Lagedal ◽  
Stefan James ◽  
Martin Jonsson ◽  
Ulf Jensen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Term Survival ◽  
Long Term Survival ◽  
Short And Long Term ◽  
St Elevation ◽  
Hospital Cardiac Arrest

scholarly journals Pulseless Electrical Activity as the Initial Cardiac Arrest Rhythm: Importance of Preexisting Left Ventricular Function

2021 ◽  
Author(s):  
Daniel I. Ambinder ◽  
Kaustubha D. Patil ◽  
Hikmet Kadioglu ◽  
Pace S. Wetstein ◽  
Richard S. Tunin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Left Ventricular Dysfunction ◽  
Coronary Occlusion ◽  
Ventricular Dysfunction ◽  
Pulseless Electrical Activity ◽  
Left Ventricular ◽  
Severe Left Ventricular Dysfunction ◽  
Acute Coronary Occlusion ◽  
Coronary Ischemia

Background Pulseless electrical activity (PEA) is a common initial rhythm in cardiac arrest. A substantial number of PEA arrests are caused by coronary ischemia in the setting of acute coronary occlusion, but the underlying mechanism is not well understood. We hypothesized that the initial rhythm in patients with acute coronary occlusion is more likely to be PEA than ventricular fibrillation in those with prearrest severe left ventricular dysfunction. Methods and Results We studied the initial cardiac arrest rhythm induced by acute left anterior descending coronary occlusion in swine without and with preexisting severe left ventricular dysfunction induced by prior infarcts in non–left anterior descending coronary territories. Balloon occlusion resulted in ventricular fibrillation in 18 of 34 naïve animals, occurring 23.5±9.0 minutes following occlusion, and PEA in 1 animal. However, all 18 animals with severe prearrest left ventricular dysfunction (ejection fraction 15±5%) developed PEA 1.7±1.1 minutes after occlusion. Conclusions Acute coronary ischemia in the setting of severe left ventricular dysfunction produces PEA because of acute pump failure, which occurs almost immediately after coronary occlusion. After the onset of coronary ischemia, PEA occurred significantly earlier than ventricular fibrillation (<2 minutes versus 20 minutes). These findings support the notion that patients with baseline left ventricular dysfunction and suspected coronary disease who develop PEA should be evaluated for acute coronary occlusion.

Abstract 15636: Percutaneous Intervention (PCI) Improves Outcomes in Out of Hospital Cardiac Arrest (OHCA) Patients Receiving Coronary Angiography

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Michael G Scutella ◽  
Francis Pike ◽  
James Fitzgibbon ◽  
Lindsey Kowalski ◽  
Clifton Callaway ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Coronary Angiography ◽  
Treatment Effect ◽  
Cerebral Performance Category ◽  
Early Brain Injury ◽  
Average Treatment Effect ◽  
Severe Brain Injury ◽  
Acute Coronary Occlusion ◽  
Improved Outcomes

Introduction: Acute coronary occlusion is common after OHCA. PCI may reduce subsequent cardiac death and improve cerebral perfusion thus improving outcomes. Recent studies suggest these benefits may be attenuated in patients with more severe brain injury. Hypothesis: PCI will more strongly associate with improved outcome than just coronary angiography (CA) after OHCA with loss of association in those with greatest brain injury. Methods: In subjects with OHCA with unclear arrest etiology, we examined the association between CA (with or without PCI) and PCI with 1) hospital survival; 2) discharge cerebral performance category (CPC); 3) discharge modified Rankin scale (mRS); 4) discharge destination. All outcomes were dichotomized and associations adjusted for propensity to perform 1) CA and 2) PCI based on associated pre-CA factors. This analysis was repeated after stratifying the cohort based on early brain injury as measured by Pittsburgh Cardiac Arrest Category (PCAC) dichotomized as PCAC 4 (severe injury) and PCAC 1-3 (mild to moderate). Results: Early (<24 h) CA was performed in 284/600 (47%) OHCA and PCI in 151/284 CA (53%). In unadjusted analysis, performance of both CA and PCI was strongly associated with improved outcomes (all p < 0.0001). Adjustment based on propensity to perform CA reduced the average treatment effect (ATE) to a non-significant 7-8% trend whereas adjustment based on propensity to perform PCI demonstrated a highly significant ATE of ~14-15% (p < 0.01) whereas those with less severe brain injury had trends to benefit with CA, which became significant (most p<0.01) with PCI. Conclusion: Early selection for CA of OHCA survivors likely to require PCI without severe brain injury is associated with substantial outcome benefits. The observed treatment effect is significantly reduced in patients with early signs of significant brain injury.

Abstract 341: A Simple Prognostic Tool for In-Hospital Death in Patients Presenting with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Andy T Tran ◽  
Anthony J Hart ◽  
John Spertus ◽  
Philip Jones ◽  
Ali O Malik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Risk Score ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Hospital Death ◽  
St Elevation ◽  
Hospital Cardiac Arrest

Background: In the emergent setting of ST-Elevation Myocardial Infarction (STEMI) complicating out-of-hospital cardiac arrest (OHCA), decisions for immediate coronary angiography are made when the likelihood of hospital survival is unknown. Estimating the risk of mortality at the time of hospital arrival might inform decisions for primary percutaneous coronary intervention. Methods: From the Cardiac Arrest Registry to Enhance Survival (CARES), we included adult OHCA patients from 2013-2018 presenting to hospitals with a STEMI. We developed a predictive model for in-hospital mortality using multivariable logistic regression to derive a scoring tool that was internally validated with bootstrap methods. Results: Of 7120 patients with OHCA and STEMI admitted at a hospital (mean age 62±13.2 years, 27% female), 3159 (44.4%) died during hospitalization. Higher age, unwitnessed arrest, non-shockable cardiac arrest rhythm, no sustained return of spontaneous circulation (ROSC) at the time of hospital admission, and resuscitation time on scene were most predictive of mortality (C-index, 0.82). Using the model β coefficients, we developed an integer risk score ranging from 0 to 10 points, corresponding to observed mortality rates of 5% to 100% (Figure 1). The odds of in-hospital mortality doubled for each 1-unit score increase (odds ratio, 2.01; 95% CI, 1.94-2.09; p<0.0001), and a score of ≥6, involving ~15% of patients, was associated with ≥85% in-hospital mortality risk. Conclusions: This risk score, based on simple prehospital characteristics, stratifies the range of in-hospital mortality from 5% to nearly 100% in OHCA patients with STEMI at the time of hospital presentation. The benefits of such a model in decision-making for immediate coronary angiography should be prospectively studied.

Sign in / Sign up

Export Citation Format

Share Document