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The effect of immediate coronary angiography after cardiac arrest without ST-segment elevation on left ventricular

Jorrit S Lemkes1, Eva M Spoormans1, Ahmet Demirkiran1

  • 1Department of Cardiology, Amsterdam University Medical Centre, Location VUmc, Amsterdam, The Netherlands.

Resuscitation
|May 1, 2021
PubMed

Insights

Immediate coronary angiography after cardiac arrest without STEMI did not improve left ventricular function. A delayed strategy showed similar outcomes, suggesting no benefit for early intervention in these specific patients.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Interventional Cardiology

Background:

  • The impact of immediate coronary angiography and percutaneous coronary intervention (PCI) on left ventricular function in successfully resuscitated cardiac arrest patients without ST-segment elevation myocardial infarction (STEMI) remains unclear.
  • Assessing left ventricular function is crucial for prognostication and management following cardiac arrest.

Purpose of the Study:

  • To evaluate the effect of immediate versus delayed coronary angiography on left ventricular function in patients resuscitated from out-of-hospital cardiac arrest without STEMI.
  • To determine if early invasive strategy improves cardiac recovery compared to a delayed approach.

Main Methods:

  • A sub-study of a multicentre trial involving 552 patients resuscitated from out-of-hospital cardiac arrest without STEMI.
  • Patients were randomized to immediate or delayed coronary angiography, with PCI performed as indicated.
  • Left ventricular ejection fraction and volumes were assessed using cardiac magnetic resonance imaging or echocardiography.

Main Results:

  • Left ventricular ejection fraction was similar between groups (45.2% immediate vs. 48.4% delayed).
  • Left ventricular end-diastolic and end-systolic volumes did not show significant differences between the immediate and delayed angiography groups.
  • No significant improvement in left ventricular dimensions or function was observed with immediate angiography.

Conclusions:

  • Immediate coronary angiography does not offer a significant advantage over a delayed strategy in improving left ventricular function or dimensions in successfully resuscitated cardiac arrest patients without STEMI.
  • These findings suggest that a delayed angiography approach may be a viable option for selected cardiac arrest survivors.
Abstract

Keywords:
Coronary angiographyLeft ventricular functionOut of hospital cardiac arrestPercutaneous coronary intervention

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