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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Acute Coronary Occlusion in Patients With Non-ST-Segment Elevation Out-of-Hospital Cardiac Arrest

Alessandro Spirito1, Lukas Vaisnora2, Athanasios Papadis2

  • 1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Journal of the American College of Cardiology
|February 1, 2023
PubMed

Insights

In out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation, acute coronary occlusions occur in 1 in 5 cases. Initial chest pain or shockable rhythm, not hemodynamic status, predicts these occlusions, which increase cardiovascular death risk.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Research

Background:

  • Current guidelines recommend hemodynamic status to guide coronary angiography (CAG) timing in out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation.
  • A delayed CAG strategy is advised for hemodynamically stable patients, while an immediate approach is recommended for unstable patients.

Purpose of the Study:

  • To assess the frequency, predictors, and clinical impact of acute coronary occlusion.
  • To compare these factors in hemodynamically stable versus unstable OHCA patients without ST-segment elevation.

Main Methods:

  • A consecutive series of unconscious OHCA patients without ST-segment elevation undergoing CAG between 2011 and 2019 were analyzed.
  • The study evaluated the frequency and predictors of acute coronary artery occlusions.
  • The impact of occlusions on all-cause and cardiovascular mortality at 1 year was assessed.

Main Results:

  • Acute coronary occlusions were identified in 19.5% of stable and 24.0% of unstable OHCA patients (P=0.407).
  • Predictors of occlusion included initial chest pain and shockable rhythm, but not hemodynamic status.
  • Acute coronary occlusion was associated with increased cardiovascular death risk (aHR: 2.74) but not all-cause death (aHR: 0.72).

Conclusions:

  • Acute coronary artery occlusions are present in approximately 20% of OHCA patients without ST-segment elevation.
  • The frequency of occlusions does not differ between stable and unstable patients.
  • Chest pain or shockable rhythm, rather than hemodynamic status, are key identifiers of acute coronary occlusion in this patient cohort, with occlusions linked to higher cardiovascular mortality.
Abstract

Keywords:
coronary angiographycoronary occlusiondeathnon–ST-segment elevationout-of-hospital cardiac arrest

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