Acute coronary angiographic findings in survivors of out-of-hospital cardiac arrest

Anyfantakis, Zacharias Alexandros; Baron, Gabriel; Aubry, P; Himbert, Dominique; Feldman, Laurent J.; Juliard, Jean‐Michel; Ricard-Hibon, A.; Burnod, Alexis; Cokkinos, Dennis V.; Steg, Philippe Gabriel

doi:10.1016/j.ahj.2008.09.016

Cited by 169 publications

(107 citation statements)

References 30 publications

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“…Moreover, a ≥90% stenosis was present in 19% of patients with no significant ECG changes, indicating potential myocardial ischemia. Although some have reported high positive and negative predictive values of ST elevation on post-ROSC ECG in selected patients, 20 our study on more unselected patients confirm findings from the Parisian Regional Out-of-Hospital Cardiac Arrest Trial (PROCAT) registry. They found at least one significant lesion in 58% of patients without ST elevation on the post-ROSC ECG.…”

Section: Discussionsupporting

confidence: 77%

“…19 A coronary occlusion was defined as TIMI grade 0 to 1 flow and considered acute or recent if there was angiographic evidence of thrombus at the site of occlusion or through the ability of opening the occluded artery by passing a guidewire easily through the lesion. 20,21 Reduced coronary flow was defined as TIMI grade 0 to 2 flow. Patients with chronic occlusions were categorized according to TIMI flow (0-3) in the remaining coronary arteries.…”

Section: Coronary Angiography Evaluationmentioning

confidence: 99%

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Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest

Stær-Jensen

Nakstad

Fossum

et al. 2015

Circ: Cardiovascular Interventions

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Background-We aimed to investigate coronary angiographic findings in unselected out-of-hospital cardiac arrest patients referred to immediate coronary angiography (ICA) irrespective of their first postresuscitation ECG and to determine whether this ECG is useful to select patients with no need of ICA. Methods and Results-All resuscitated patients admitted after out-of-hospital cardiac arrest without a clear noncardiac cause underwent ICA. Patients were retrospectively grouped according to the postresuscitation ECG blinded for ICA results: (1) ST elevation or presumably new left bundle branch block, (2) other ECG signs indicating myocardial ischemia, and (3) no ECG signs indicating myocardial ischemia. All coronary angiograms were reevaluated blinded for postresuscitation ECGs. Two hundred and ten patients were included with mean age 62±12 years. Six-months survival with good neurological outcome was 54%. Reduced Thrombolysis in Myocardial Infarction flow (0-2) was found in 55%, 34%, and 18% and a ≥90% coronary stenosis was present in 25%, 27%, and 19% of patients in group 1, 2, and 3, respectively. An acute coronary occlusion was found in 11% of patients in group 3. ST elevation/left bundle branch block identified patients with reduced Thrombolysis in Myocardial Infarction (0-2) flow with 70% sensitivity and 62% specificity. Among patients with initial nonshockable rhythms (24%), 32% had significantly reduced Thrombolysis in Myocardial Infarction flow. Conclusions-Initial ECG findings are not reliable in detecting patients with an indication for ICA after experiencing a cardiac arrest. Even in the absence of ECG changes indicating myocardial ischemia, an acute culprit lesion may be present and patients may benefit from emergent revascularization. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01239420.(Circ Cardiovasc Interv. 2015;8:e002784.

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Section: Discussionsupporting

confidence: 77%

Section: Coronary Angiography Evaluationmentioning

confidence: 99%

Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest

Stær-Jensen

Nakstad

Fossum

et al. 2015

Circ: Cardiovascular Interventions

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“…14,15 Therefore, a 12-lead ECG should be obtained as soon as possible to detect ST elevation or new or presumably new left bundlebranch block. When there is high suspicion of acute myocardial infarction (AMI), local protocols for treatment of AMI and coronary reperfusion should be activated.…”

Section: Overview Of Post-cardiac Arrest Carementioning

confidence: 99%

Part 9: Post–Cardiac Arrest Care

Peberdy¹,

Callaway²,

Neumar³

et al. 2010

Circulation

1,455

838

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“…Many clinicians may advocate waiting to assess neurological recovery before proceeding to angiography. 63 Proponents of an early interventional approach suggest that 40% of cardiac arrests caused by unstable coronary plaques may be missed if decision making is based on ECG criteria alone 58,60 (Table 3). A recent study of cardiac arrest patients undergoing coronary angiography found that significant coronary lesions occur in up to 66% of patients without ST elevation.…”

Section: Management Of Acute Coronary Syndrome In the Ohca Patientmentioning

confidence: 99%

Post Cardiac Arrest Syndrome

et al. 2011

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Acute coronary angiographic findings in survivors of out-of-hospital cardiac arrest

Cited by 169 publications

References 30 publications

Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest

Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest

Part 9: Post–Cardiac Arrest Care

Post Cardiac Arrest Syndrome

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