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Coronary Occlusion in Patients With Non-ST Elevation Cardiac Arrest
Quick Takes
- The authors present findings from a single-center, retrospective analysis evaluating predictors of acute coronary occlusion and its impact on clinical outcomes among patients with non-ST elevation MI and out-of-hospital cardiac arrest.
- Acute coronary occlusion was present in 20% of patients and presence of coronary occlusion was associated with increased risk of CV death but not all-cause death.
- Presence of chest pain and shockable rhythm, not hemodynamic stability, predicted presence of coronary occlusion.
Study Questions:
What are the frequency, predictors, and clinical impact of acute coronary occlusion in hemodynamically stable and unstable out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation?
Methods:
Consecutive unconscious OHCA patients without ST-segment elevation who were undergoing coronary angiography at Bern University Hospital (Bern, Switzerland) between 2011 and 2019 were included. Frequency and predictors of acute coronary artery occlusions and their impact on all-cause and cardiovascular (CV) mortality at 1 year were assessed.
Results:
Among the 386 patients, 169 (43.8%) were hemodynamically stable. Acute coronary occlusions were found in 19.5% of stable and 24.0% of unstable OHCA patients (p = 0.407), and the presence of these occlusions was predicted by initial chest pain and shockable rhythm, but not by hemodynamic status. Acute coronary occlusion was associated with an increased risk of CV death (adjusted hazard ratio [aHR], 2.74; 95% confidence interval [CI], 1.22-6.15) but not of all-cause death (aHR, 0.72; 95% CI, 0.44-1.18). Hemodynamic instability was not predictive of fatal outcomes.
Conclusions:
Acute coronary artery occlusions were found in one in five OHCA patients without ST-segment elevation. The frequency of these occlusions did not differ between stable and unstable patients, and the occlusions were associated with a higher risk of CV death. In OHCA patients without ST-segment elevation, chest pain or shockable rhythm rather than hemodynamic status identifies patients with acute coronary occlusion.
Perspective:
The authors present findings from a single-center, retrospective analysis evaluating predictors of acute coronary occlusion, and its impact on clinical outcomes among patients with OHCA with non-ST elevation MI. Acute coronary occlusion was present in 20% of patients and presence of coronary occlusion was associated with increased risk of CV death but not all-cause death. Presence of chest pain and shockable rhythm, not hemodynamic stability, predicted presence of coronary occlusion. These findings question the current guideline recommendation of using hemodynamic stability as a gauge to perform invasive angiography to identify patients with coronary occlusion. Findings suggest that underlying rhythm and presence of chest pain prior to arrest may be important variables regardless of hemodynamic status.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging, Chronic Angina
Keywords: Arrhythmias, Cardiac, Chest Pain, Coronary Angiography, Coronary Occlusion, Heart Arrest, Hemodynamics, Myocardial Infarction, Non-ST Elevated Myocardial Infarction, Out-of-Hospital Cardiac Arrest, Risk, Secondary Prevention, Shock
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