Clinical Factors Associated with Obstructive Coronary Artery Disease in Patients with Out-of-Hospital Cardiac Arrest: Data from the Korean Cardiac Arrest Research Consortium (KoCARC) Registry

Abstract

Background Although coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA), there has been no convinced data on the necessity of routine invasive coronary angiography (ICA) in OHCA. We investigated clinical factors associated with obstructive CAD in OHCA. Methods Data from 516 OHCA patients (mean age 58 years, 83% men) who underwent ICA after resuscitation was obtained from a nation-wide OHCA registry. Obstructive CAD was defined as the lesions with diameter stenosis ≥ 50% on ICA. Independent clinical predictors for obstructive CAD were evaluated using multiple logistic regression analysis, and their prediction performance was compared using area under the receiver operating characteristic curve with 10,000 repeated random permutations. Results Among study patients, 254 (49%) had obstructive CAD. Those with obstructive CAD were older (61 vs. 55 years, P < 0.001) and had higher prevalence of hypertension (54% vs. 36%, P < 0.001), diabetes mellitus (29% vs. 21%, P = 0.032), positive cardiac enzyme (84% vs. 74%, P = 0.010) and initial shockable rhythm (70% vs. 61%, P = 0.033). In multiple logistic regression analysis, old age (≥ 60 years) (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.36–3.00; P = 0.001), hypertension (OR, 1.74; 95% CI, 1.18–2.57; P = 0.005), positive cardiac enzyme (OR, 1.72; 95% CI, 1.09–2.70; P = 0.019), and initial shockable rhythm (OR, 1.71; 95% CI, 1.16–2.54; P = 0.007) were associated with obstructive CAD. Prediction ability for obstructive CAD increased proportionally when these 4 factors were sequentially combined ( P < 0.001). Conclusion In patients with OHCA, those with old age, hypertension, positive cardiac enzyme and initial shockable rhythm were associated with obstructive CAD. Early ICA should be considered in these patients.

Management of post-cardiac arrest syndrome

“…Patients suffering out-of-hospital cardiac arrest, those with old age, hypertension, positive cardiac enzyme, and initial shockable rhythm were associated with obstructive coronary artery disease. Early invasive coronary angiography should be considered in these patients [14].…”

Myocardial infarction type 1 is frequent in refractory out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR)

“…For patients with refractory CA without ROSC, current guidelines recommend an urgent coronary angiography only if it appears logistically feasible and if an acute coronary syndrome is suspected 1 . Shockable primary rhythm is associated with both cardiac cause for collapse 16 and improved outcome in ECPR 17 and is consequently one of the factors in favor of ECPR initiation 6 . In addition, logistics in a catheterization laboratory appear ideal for www.nature.com/scientificreports www.nature.com/scientificreports/ rapid, sterile, effective, and safe cannulation to establish VA-ECMO under CPR.…”

Development a clinical prediction model of the neurological outcome for patients with coma and survived 24 hours after cardiopulmonary resuscitation

“…Although relevant studies had shown that initial shockable rhythm was closely associated with the prognosis of patients with cardiac arrest, 21‐23 We used a nonshockable initial rhythm instead of initial shockable rhythm in our study. The reasons were as follows: (a) nonshockable initial rhythm could be quickly recorded before cardiac arrest occurred because nonshockable initial rhythm taken a relatively long time to develop into cardiac arrest 24 ; (b) the most of the initial shockable rhythm of cardiac arrest were developed from nonshockable initial rhythm 24 ; (c) The time that initial shockable rhythm developed into cardiac arrest was concise, as a result, that the discover and diagnose the initial shockable rhythm with very difficult neither in or out of the hospital.…”

“…if tracheal intubation and ventilator were given in time, hypoxemia could not be quickly relieved, and more importantly, a simple respirator was the first and most frequently received respiratory support devices, which with poor respiratory support. 20 Although relevant studies had shown that initial shockable rhythm was closely associated with the prognosis of patients with cardiac arrest, [21][22][23] We used a nonshockable initial rhythm instead of initial shockable rhythm in our study. The reasons were as follows:…”