Coronary Angiography in Cardiac Arrest Survivors

Study Questions:

What are the outcomes and coronary angiographic findings in post–cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI)?

Methods:

This was a retrospective evaluation of a post–cardiac arrest registry. The International Cardiac Arrest (INTCAR) cardiology registry, comprising 34 centers in Europe and the United States, describes the characteristics and outcomes of post-resuscitation cardiac arrest care. The authors collected retrospective and prospective data on 754 comatose patients who survived to hospital admission after cardiac arrest from February 2006 to May 2011. The primary outcome was survival to hospital discharge, with a secondary outcome of functional status after discharge.

Results:

The database consisted of 746 comatose post–cardiac arrest patients including 198 with STEMI (26.5%) and 548 without STEMI (73.5%). Overall survival was greater in those with STEMI compared with those without (55.1% vs. 41.3%; p = 0.001), whereas in all patients who underwent immediate coronary angiography, survival was similar between those with and without STEMI (54.7% vs. 57.9%; p = 0.60). A culprit vessel was more frequently identified in those with STEMI, but also in one-third of patients without STEMI (80.2% vs. 33.2%; p = 0.001). The majority of culprit vessels were occluded (STEMI, 92.7%; no STEMI, 69.2%; p < 0.0001). An occluded culprit vessel was found in 74.3% of STEMI patients and in 22.9% of no STEMI patients. Among cardiac arrest survivors discharged from the hospital who had presented without STEMI, coronary angiography was associated with better functional outcome (93.3% vs. 78.7%; p < 0.003).

Conclusions:

The authors concluded that early coronary angiography is associated with improved functional outcome among resuscitated patients with and without STEMI.

Perspective:

This registry data suggests that the combination of therapeutic hypothermia and early coronary angiography is beneficial for post–cardiac arrest patients with and without STEMI. Early coronary angiography may provide useful information and can direct therapy, particularly identifying those who may benefit from acute coronary reperfusion therapy in those without STEMI as well as those with STEMI. Resuscitated cardiac arrest patients who were responsive or awake on evaluation at the hospital were not included in the current analysis, and whether early angiography benefits those patients needs further study.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Angiography, Coronary Angiography, Heart Arrest, Hypothermia, Induced, Myocardial Infarction, Myocardial Reperfusion, Patient Outcome Assessment, Resuscitation, Survival


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