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Coronary angiography in patients after cardiac arrest without ST-elevation myocardial infarction : A retrospective
Matthias Mueller1, Daniela Dziekan1, Michael Poppe2
1Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090, Vienna, Austria.
Insights
Coronary angiography is recommended for sudden cardiac arrest patients without ST-elevation, but its use varies. A study found many patients had treatable coronary artery disease, suggesting current selection criteria may be suboptimal.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Coronary artery disease (CAD) is a leading cause of sudden cardiac arrest (SCA).
- Guidelines recommend coronary angiography (CAG) for SCA patients even without ST-elevation (STE) after return of spontaneous circulation (ROSC).
- Implementation of this recommendation in routine practice remains suboptimal.
Purpose of the Study:
- To evaluate the rate and timing of CAG in SCA patients without STE after ROSC.
- To analyze factors influencing the decision to perform or withhold CAG.
- To determine if clinical signs and symptoms predict treatable CAD in these patients.
Main Methods:
- Retrospective database analysis of SCA patients (≥18 years) with presumed cardiac cause and sustained ROSC without STE.
- Primary endpoints: rate and timing of CAG.
- Secondary endpoints: reasons for/against CAG, association of signs/symptoms with treatable CAD.
Main Results:
- Of 1203 screened patients, 645 were included; CAG was performed in 53.2%.
- Occlusive CAD was diagnosed in 62.4% of those who underwent CAG, with 71.0% receiving treatment.
- Factors associated with withholding CAG included age ≥70, female sex, non-shockable rhythms, and cardiomyopathy.
Conclusions:
- A significant proportion of SCA patients without STE after ROSC have treatable occlusive CAD.
- The current criteria for selecting patients for CAG may be suboptimal.
- Further research is needed to optimize patient selection for CAG in this population.
Background:
Coronary artery disease (CAD) is the most common cause of sudden cardiac arrest (SCA). Although coronary angiography (CAG) should be performed also in the absence of ST-elevation (STE) after sustained return of spontaneous circulation (ROSC), this recommendation is not well implemented in daily routine.
Methods:
A retrospective database analysis was conducted in a tertiary care center between January 2005 and December 2014. We included all SCA patients aged ≥ 18 years with presumed cardiac cause and sustained ROSC in the absence of STE at hospital admission. The rate and timing of CAG were defined as the primary endpoints. As secondary endpoints, the reasons pro and contra CAG were analyzed. Furthermore, we observed if the signs and symptoms used for decision making occurred more often in patients with treatable CAD.
Results:
We included 645 (53.6%) of the 1203 screened patients, CAG was performed in 343 (53.2%) patients with a diagnosis of occlusive CAD in 214 (62.4%) patients. Of these, 151 (71.0%) patients had occlusive CAD treated with coronary intervention, thrombus aspiration, or coronary artery bypass grafting. In an adjusted binomial logistic regression analysis, age ≥ 70 years, female sex, non-shockable rhythms, and cardiomyopathy were associated with withholding of CAG. In patients diagnosed and treated with occlusive CAD, initially shockable rhythms, previously diagnosed CAD, hypertension, and smoking were found more often.
Conclusion:
Although selection bias is unavoidable due to the retrospective design of this study, a high proportion of the examined patients had occlusive CAD. The criteria used for patient selection may be suboptimal.
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