scholarly journals Role of coronary angiography in patients with a non-diagnostic electrocardiogram following out of hospital cardiac arrest: Rationale and design of the multicentre randomized controlled COUPE trial

2019 ◽  
Vol 9 (4_suppl) ◽  
pp. S131-S137
Author(s):  
Ana Viana-Tejedor ◽  
Albert Ariza-Solé ◽  
Manuel Martínez-Sellés ◽  
Manuel Jiménez Mena ◽  
Montserrat Vila ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Cerebral Performance Category ◽  
Coronary Intervention ◽  
Controlled Clinical Trial ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
Randomized Controlled ◽  
Hospital Cardiac Arrest

Background: Coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA). The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following cardiac arrest in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear. Aims: We aim to assess whether emergency CAG and PCI, when indicated, will improve survival with good neurological outcome in post-OHCA patients without STEMI who remain comatose. Methods: COUPE is a prospective, multicentre and randomized controlled clinical trial. A total of 166 survivors of OHCA without STEMI will be included. Potentially non-cardiac aetiology of the cardiac arrest will be ruled out prior to randomization. Randomization will be 1:1 for emergency (within 2 h) or deferred (performed before discharge) CAG. Both groups will receive routine care in the intensive cardiac care unit, including therapeutic hypothermia. The primary efficacy endpoint is a composite of in-hospital survival free of severe dependence, which will be evaluated using the Cerebral Performance Category Scale. The safety endpoint will be a composite of major adverse cardiac events including death, reinfarction, bleeding and ventricular arrhythmias. Conclusions: This study will assess the efficacy of an emergency CAG versus a deferred one in OHCA patients without STEMI in terms of survival and neurological impairment.

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 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

Early coronary angiography and percutaneous coronary intervention for out of hospital cardiac arrest survivors without ST-segment elevation: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Po Huang ◽  
Qingquan Liu ◽  
Yuhong Guo ◽  
Bo Li ◽  
Xiaolei Fang
Keyword(s):  
Meta Analysis ◽  
Coronary Intervention ◽  
Controlled Study ◽  
Short Term ◽  
St Segment Elevation ◽  
Randomized Controlled ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Hospital Cardiac Arrest

Abstract Objective: The meta-analysis aims to identify whether out of hospital cardiac arrest (OHCA) survivors of non ST-segment elevation (NSTE) can benefit from early coronary angiography (CAG) and percutaneous coronary intervention (PCI).Methods: The relevant studies from MEDLINE, Cochrane Library, Embase were searched by two independent investigators using a variety of keywords. Stata software (version 12.0, Stata Corp LP, College Station, TX, USA) was used for statistical analysis. Results: A total of 12 studies (9 observational studies, 1 cohort study and 2 randomized control trials) were identified and incorporated into the meta-analysis. For overall analysis, the strategy of early angiography was associated with decreased short-term (hospital discharged) mortality (RR=0.72, 95% CI=0.56-0.93, P=0.000) and long-term (follow up) mortality (RR=0.84, 95% CI=0.71-0.99, P=0.007). However, when analyzed in the subgroup of randomized controlled study, the strategy of early angiography didn’t have survival benefit in the randomized controlled study group for short-term mortality (RR=1.12, 95% CI=0.89-1.41, P=0.331) and long-term mortality (RR=1.06, 95% CI=0.85-1.32, P=0.572). Meanwhile, our analysis found that, if early CAG performed, PCI followed by CAG is not associated with hospital discharged mortality (RR=1.14, 95% CI=0.96-1.37, P=0.132) compared with CAG alone. No significant differences between the groups were found in the remaining secondary endpoints.Conclusion: Due to the observational nature of the studies available, we may consider that early CAG and PCI is not be recommended for patients with NSTE OHCA.

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 Women have a worse prognosis and undergo fewer coronary angiographies after out-of-hospital cardiac arrest than men

2017 ◽  
Vol 7 (5) ◽  
pp. 414-422 ◽  
Author(s):  
Matilde Winther-Jensen ◽  
Christian Hassager ◽  
Jesper Kjaergaard ◽  
John Bro-Jeppesen ◽  
Jakob H Thomsen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Functional Status ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Percutaneous Coronary ◽  
Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest is more often reported in men than in women. Objectives: We aimed to assess sex-related differences in post-resuscitation care; especially with regards to coronary angiography, percutaneous coronary intervention, mortality and functional status after out-of-hospital cardiac arrest. Methods: We included 704 consecutive adult out-of-hospital cardiac arrest-patients with cardiac aetiology in the Copenhagen area from 2007–2011. Utstein guidelines were used for the pre-hospital data. Vital status and pre-arrest comorbidities were acquired from Danish registries and review of patient charts. Logistic regression was used to assess differences in functional status and use of post-resuscitation care. Cox regression was used to assess differences in 30-day mortality. We used ‘smcfcs’ and ‘mice’ imputation to handle missing data. Results: Female sex was associated with higher 30-day mortality after adjusting for age and comorbidity (hazard ratio (HR): 1.42, confidence interval (CI): 1.13–1.79, p<0.01), this was not significant when adjusting for primary rhythm (HR: 1.12, CI: 0.88–1.42, p=0.37). Women less frequently received coronary angiography <24 h in multiple regression after out-of-hospital cardiac arrest (odds ratio (OR)CAG=0.55, CI: 0.31–0.97, p=0.041), however no difference in percutaneous coronary intervention was found (ORPCI=0.55, CI: 0.23–1.36, p=0.19). Coronary artery bypass grafting was less often performed in women (ORCABG: 0.10, CI: 0.01–0.78, p=0.03). There was no difference in functional status at discharge between men and women ( p=1). Conclusion: Female sex was not significantly associated with higher mortality when adjusting for confounders. Women less often underwent coronary angiography and coronary artery bypass grafting, but it is not clear whether this difference can be explained by other factors, or an actual under-treatment in women.

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