Clinical factors associated with significant coronary lesions following out-of-hospital cardiac arrest.
cardiac arrest
coronary angiography
coronary artery disease
resuscitation
Journal
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
ISSN: 1553-2712
Titre abrégé: Acad Emerg Med
Pays: United States
ID NLM: 9418450
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
revised:
31
10
2021
received:
14
07
2021
accepted:
09
11
2021
pubmed:
13
11
2021
medline:
29
4
2022
entrez:
12
11
2021
Statut:
ppublish
Résumé
Out-of-hospital cardiac arrest (OHCA) afflicts >350,000 people annually in the United States. While postarrest coronary angiography (CAG) with percutaneous coronary intervention (PCI) has been associated with improved survival in observational cohorts, substantial uncertainty exists regarding patient selection for postarrest CAG. We tested the hypothesis that symptoms consistent with acute coronary syndrome (ACS), including chest discomfort, prior to OHCAs are associated with significant coronary lesions identified on postarrest CAG. We conducted a multicenter retrospective cohort study among eight regional hospitals. Adult patients who experienced atraumatic OHCA with successful initial resuscitation and subsequent CAG between January 2015 and December 2019 were included. We collected data on prehospital documentation of potential ACS symptoms prior to OHCA as well as clinical factors readily available during postarrest care. The primary outcome in multivariable regression modeling was the presence of significant coronary lesions (defined as >50% stenosis of left main or >75% stenosis of other coronary arteries). Four-hundred patients were included. Median (interquartile range) age was 59 (51-69) years; 31% were female. At least one significant stenosis was found in 62%, of whom 71% received PCI. Clinical factors independently associated with a significant lesion included a history of myocardial infarction (adjusted odds ratio [aOR] = 6.5, [95% confidence interval {CI} = 1.3 to 32.4], p = 0.02), prearrest chest discomfort (aOR = 4.8 [95% CI = 2.1 to 11.8], p ≤ 0.001), ST-segment elevations (aOR = 3.2 [95% CI = 1.7 to 6.3], p < 0.001), and an initial shockable rhythm (aOR = 1.9 [95% CI = 1.0 to 3.4], p = 0.05). Among survivors of OHCA receiving CAG, history of prearrest chest discomfort was significantly and independently associated with significant coronary artery lesions on postarrest CAG. This suggests that we may be able to use prearrest symptoms to better risk stratify patients following OHCA to decide who will benefit from invasive angiography.
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
456-464Subventions
Organisme : NINDS NIH HHS
ID : R21 NS109763
Pays : United States
Informations de copyright
© 2021 Society for Academic Emergency Medicine.
Références
Jentzer JC, Scutella M, Pike F, et al. Early coronary angiography and percutaneous coronary intervention are associated with improved outcomes after out of hospital cardiac arrest. Resuscitation. 2018;123:15-21. doi:10.1016/j.resuscitation.2017.12.004
Abella BS, Gaieski DF. Coronary angiography after cardiac arrest - the right timing or the right patients? N Engl J Med. 2019;380(15):1474-1475. doi:10.1056/NEJMe1901651
Kern KB, Rahman O. Emergent percutaneous coronary intervention for resuscitated victims of out-of-hospital cardiac arrest. Catheter Cardiovasc Interv. 2010;75(4):616-624. doi:10.1002/ccd.22192
Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med. 1997;336(23):1629-1633. doi:10.1056/NEJM199706053362302
Rab T, Kern KB, Tamis-Holland JE, et al. Cardiac arrest: a treatment algorithm for emergent invasive cardiac procedures in the resuscitated comatose patient. J Am Coll Cardiol. 2015;66(1):62-73. doi:10.1016/j.jacc.2015.05.009
Staudacher II, den Uil C, Jewbali L, et al. Timing of coronary angiography in survivors of out-of-hospital cardiac arrest without obvious extracardiac causes. Resuscitation. 2018;123:98-104. doi:10.1016/j.resuscitation.2017.11.046
Dumas F, Bougouin W, Geri G, et al. Emergency percutaneous coronary intervention in post-cardiac arrest patients without ST-segment elevation pattern: insights from the PROCAT II registry. JACC Cardiovasc Interv. 2016;9(10):1011-1018. doi:10.1016/j.jcin.2016.02.001
Camuglia AC, Randhawa VK, Lavi S, Walters DL. Cardiac catheterization is associated with superior outcomes for survivors of out of hospital cardiac arrest: review and meta-analysis. Resuscitation. 2014;85(11):1533-1540. doi:10.1016/j.resuscitation.2014.08.025
Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. doi:10.1093/eurheartj/ehx393
O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78-e140. doi:10.1016/j.jacc.2012.11.019
Monsieurs KG, Nolan JP, Bossaert LL, et al. European Resuscitation Council guidelines for resuscitation 2015: section 1. Executive summary. Resuscitation. 2015;95:1-80. doi:10.1016/j.resuscitation.2015.07.038
McFadden P, Reynolds JC, Madder RD, Brown M. Diagnostic test accuracy of the initial electrocardiogram after resuscitation from cardiac arrest to indicate invasive coronary angiographic findings and attempted revascularization: a systematic review and meta-analysis. Resuscitation. 2021;160:20-36. doi:10.1016/j.resuscitation.2020.11.039
Nikolaou NI, Welsford M, Beygui F, et al. Part 5: acute coronary syndromes: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with treatment recommendations. Resuscitation. 2015;95:121. doi:10.1016/j.resuscitation.2015.07.043
Noc M, Fajadet J, Lassen JF, et al. Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European Association for Percutaneous Cardiovascular Interventions (EAPCI)/Stent for Life (SFL) groups. EuroIntervention. 2014;10(1):31-37. doi:10.4244/EIJV10I1A7
Patel N, Patel NJ, Macon CJ, et al. Trends and outcomes of coronary angiography and percutaneous coronary intervention after out-of-hospital cardiac arrest associated with ventricular fibrillation or pulseless ventricular tachycardia. JAMA Cardiol. 2016;1(8):890-899. doi:10.1001/jamacardio.2016.2860
Dankiewicz J, Nielsen N, Annborn M, et al. Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography: a post hoc analysis from the TTM trial. Intensive Care Med. 2015;41(5):856-864. doi:10.1007/s00134-015-3735-z
Nikolaou NI, Netherton S, Welsford M, et al. A systematic review and meta-analysis of the effect of routine early angiography in patients with return of spontaneous circulation after out-of-hospital cardiac arrest. Resuscitation. 2021;163:28-48. doi:10.1016/j.resuscitation.2021.03.019
Gonzalez MR, Esposito EC, Leary M, et al. Initial clinical predictors of significant coronary lesions after resuscitation from cardiac arrest. Ther Hypothermia Temp Manag. 2012;2(2):73-77. doi:10.1089/ther.2012.0012
Held EP, Chugh SS. Warning signs of impending acute cardiac events. Circulation. 2018;138(16):1617-1619. doi:10.1161/CIRCULATIONAHA.118.036217
Chugh SS, Reinier K, Teodorescu C, et al. Epidemiology of sudden cardiac death: clinical and research implications. Prog Cardiovasc Dis. 2008;51(3):213-228. doi:10.1016/j.pcad.2008.06.003
Lipinski M, Do D, Morise A, Froelicher V. What percent luminal stenosis should be used to define angiographic coronary artery disease for noninvasive test evaluation? Ann Noninvasive Electrocardiol. 2002;7(2):98-105. doi:10.1111/j.1542-474X.2002.tb00149.x
Baldi E, Schnaubelt S, Caputo ML, et al. Association of timing of electrocardiogram acquisition after return of spontaneous circulation with coronary angiography findings in patients with out-of-hospital cardiac arrest. JAMA Netw Open. 2021;4(1):e2032875. doi:10.1001/jamanetworkopen.2020.32875
Ajam K, Gold LS, Beck SS, Damon S, Phelps R, Rea TD. Reliability of the cerebral performance category to classify neurological status among survivors of ventricular fibrillation arrest: a cohort study. Scand J Trauma Resusc Emerg Med. 2011;19:38. doi:10.1186/1757-7241-19-38
Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1(7905):480-484. doi:10.1016/s0140-6736(75)92830-5
Lagedal R, Elfwén L, Jonsson M, et al. Coronary angiographic findings after cardiac arrest in relation to ECG and comorbidity. Resuscitation. 2020;146:213-219. doi:10.1016/j.resuscitation.2019.09.021
May T, Skinner K, Unger B, et al. Coronary angiography and intervention in women resuscitated from sudden cardiac death. J Am Heart Assoc. 2020;9(7):e015629. doi:10.1161/JAHA.119.015629
Hanuschak TA, Peng Y, Day A, et al. Patient and hospital factors predict use of coronary angiography in out-of-hospital cardiac arrest patients. Resuscitation. 2019;138:182-189. doi:10.1016/j.resuscitation.2019.03.013
Bell SM, Kovach C, Kataruka A, Brown J, Hira RS. Management of out-of-hospital cardiac arrest complicating acute coronary syndromes. Curr Cardiol Rep. 2019;21(11):146. doi:10.1007/s11886-019-1249-y
Lemkes JS, Janssens GN, van der Hoeven NW, et al. Coronary angiography after cardiac arrest without ST-segment elevation. N Engl J Med. 2019;380(15):1397-1407. doi:10.1056/NEJMoa1816897