Association Between Multivessel Coronary Artery Disease and Return of Spontaneous Circulation Interval in Acute
Kazuya Tateishi1, Daisuke Abe2, Kou Suzuki2
1Department of Cardiovascular Medicine, Chiba University Hospital.
Insights
In acute coronary syndrome (ACS) patients with out-of-hospital cardiac arrest (OHCA), multivessel coronary artery disease (MVD) negatively impacts resuscitation success. Coronary angiography findings like collateral flow did not predict the return of spontaneous circulation (ROSC) interval.
Area of Science:
- Cardiology
- Emergency Medicine
- Intensive Care
Background:
- Acute coronary syndrome (ACS) is a leading cause of out-of-hospital cardiac arrest (OHCA).
- The prognostic value of coronary imaging findings on resuscitation outcomes in ACS-related OHCA remains unclear.
- Understanding factors influencing return of spontaneous circulation (ROSC) is critical for improving survival rates.
Purpose of the Study:
- To investigate the relationship between coronary angiography findings and the ROSC interval in ACS patients experiencing OHCA.
- To identify predictors of successful resuscitation in this patient population.
- To assess the impact of multivessel coronary artery disease (MVD) on resuscitation ease.
Main Methods:
- A cohort study included 58 ACS patients with OHCA, ventricular fibrillation (VF) as initial rhythm, and successful resuscitation.
- Patients were categorized into early ROSC (≤20 minutes) and late ROSC (>20 minutes) groups.
- Coronary angiography findings, including collateral artery status (Rentrop II-III) and coronary blood flow (TIMI III), were analyzed and compared between groups.
Main Results:
- No significant differences were observed in collateral artery status (Rentrop II-III) or TIMI III flow between early and late ROSC groups.
- The incidence of multivessel coronary artery disease (MVD) was significantly lower in the early ROSC group (16.7%) compared to the late ROSC group (58.8%) (P = 0.001).
- Collateral flow and TIMI III flow were not associated with the ease of resuscitation, but MVD appeared to negatively impact resuscitation outcomes in VF patients.
Conclusions:
- Coronary collateral circulation and TIMI flow are not associated with the ease of achieving ROSC in ACS patients with OHCA.
- Multivessel coronary artery disease (MVD) is associated with a longer ROSC interval and may negatively impact resuscitation success in ACS patients with OHCA and VF.
- Further research is warranted to elucidate the mechanisms by which MVD affects resuscitation outcomes.
Abstract:
Acute coronary syndrome (ACS) is the major cause of out-of-hospital cardiac arrest (OHCA). The relationship between the findings from the study of coronary images and return of spontaneous circulation (ROSC) interval is still unknown. Hence, we investigated this relationship in ACS patients with OHCA.A cohort of 2779 patients was admitted to our emergency center due to cardiopulmonary arrest (CPA) between April 2011 and March 2015. We included ACS patients who had CPA with ventricular fibrillation (VF) as an initial rhythm, were successfully resuscitated, underwent coronary angiography (CAG), had a culprit lesion, and were diagnosed with ACS (n = 58; age, 63.7 ± 12.0 years; 93.1% male).We divided the 58 patients into two groups, an early ROSC group (ROSC ≤ 20 minutes: E-ROSC) and a late ROSC group (ROSC > 20 minutes: L-ROSC), and then analyzed their characteristics.The finding of a collateral artery for the culprit lesion location, Rentrop II-III, and TIMI III flow on CAG on arrival presented no significant differences between the two groups (Rentrop II-III: 25.0% versus 23.5%, P = 0.90; TIMI III: 33.3% versus 35.3%, P = 0.88). The incidence of multivessel coronary artery disease (MVD) was lower in the E-ROSC group than in the L-ROSC group (16.7% versus 58.8%, P = 0.001).Collateral and TIMI flow were not associated with ease of resuscitation, but MVD may have a negative impact on resuscitation, especially in VF patients.
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