Outcomes of Comatose Cardiac Arrest Survivors With and Without ST-Segment Elevation Myocardial Infarction: Importance of Coronary Angiography
Karl B Kern, Kapildeo Lotun, Nainesh Patel, Michael R Mooney, Ryan D Hollenbeck, John A McPherson, Paul W McMullan, Barbara Unger, Chiu-Hsieh Hsu, David B Seder, INTCAR-Cardiology Registry, Karl B Kern, Kapildeo Lotun, Nainesh Patel, Michael R Mooney, Ryan D Hollenbeck, John A McPherson, Paul W McMullan, Barbara Unger, Chiu-Hsieh Hsu, David B Seder, INTCAR-Cardiology Registry
Abstract
Objectives: The aim of this study was to compare outcomes and coronary angiographic findings in post-cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI).
Background: The 2013 STEMI guidelines recommend performing immediate angiography in resuscitated patients whose initial electrocardiogram shows STEMI. The optimal approach for those without STEMI post-cardiac arrest is less clear.
Methods: A retrospective evaluation of a post-cardiac arrest registry was performed.
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: Early coronary angiography is associated with improved functional outcome among resuscitated patients with and without STEMI. Resuscitated patients with a presumed cardiac etiology appear to benefit from immediate coronary angiography.
Keywords: STEMI; cardiac arrest; coronary angiography; hypothermia; post-resuscitation syndrome.
Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed