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Coronary angiography and percutaneous coronary intervention in cardiac arrest patients without return of spontaneous

Daniel Rob1, Petra Kavalkova1, Jana Smalcova1

  • 12nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.

Resuscitation
|April 3, 2022
PubMed

Insights

Out-of-hospital cardiac arrest (OHCA) patients without return of spontaneous circulation (ROSC) have higher acute coronary occlusion rates. Percutaneous coronary intervention (PCI) is feasible and successful in these patients, offering achievable survival.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Interventional Cardiology

Background:

  • Out-of-hospital cardiac arrest (OHCA) is a critical medical emergency.
  • Return of spontaneous circulation (ROSC) on hospital admission is a key prognostic factor.
  • Understanding coronary findings and intervention outcomes in OHCA patients without ROSC is crucial for treatment optimization.

Purpose of the Study:

  • To investigate coronary angiography (CAG) findings in OHCA patients without ROSC.
  • To evaluate the results and outcomes of percutaneous coronary intervention (PCI) in OHCA patients without ROSC.
  • To compare these findings with OHCA patients who achieved ROSC.

Main Methods:

  • Analysis of the OHCA register from January 2012 to December 2020.
  • Comparison of coronary angiography (CAG) and percutaneous coronary intervention (PCI) data between OHCA patients with and without ROSC on admission.
  • Evaluation of patient demographics, resuscitation times, coronary artery disease prevalence, acute coronary occlusions, PCI success rates, and 30-day survival.

Main Results:

  • 163 out of 697 OHCA patients (23%) did not have ROSC on admission.
  • Patients without ROSC were younger and had longer resuscitation times.
  • Higher rates of acute coronary occlusions, particularly left main stem, were observed in patients without ROSC (42% vs. 33%).
  • PCI was performed in 50% of patients without ROSC with an 86% success rate.
  • Thirty-day survival was 24% in patients without ROSC versus 70% in patients with ROSC.

Conclusions:

  • OHCA patients without ROSC exhibit higher acute coronary occlusion rates compared to those with prehospital ROSC.
  • Percutaneous coronary intervention (PCI) is a feasible and successful treatment option for OHCA patients without ROSC.
  • Meaningful survival is achievable in OHCA patients admitted without ROSC, even after prolonged resuscitation efforts.
Abstract

Keywords:
Coronary angiographyExtracorporeal life supportOut of hospital cardiac arrestPercutaneous coronary interventionReturn of spontaneous circulation

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