Coronary Angiography in Patients with and without STEMI Following Out-of-Hospital Cardiac Arrest

Abstract

Introduction: Little is known about discrepancies between patients who present with or without STEMI following out-of-hospital cardiac arrest (OHCA). Material and Methods: All patients with OHCA who were admitted to our hospital between January 1st 2008 and December 31st 2013 were classified according to their initial laboratory and electrocardiographic findings into STEMI, NSTEMI or no ACS. Results: Overall, 147 patients [32 STEMI (21.8%), 28 NSTEMI (19.0%) and 87 no ACS (59.2%)] were included with a mean age of 63.7 ± 13.3 years; there were 84 men (57.1%) and 63 (42.9%) women. Of these, 63 patients (51.7%) received coronary angiography [29 STEMI (90.6%), 9 NSTEMI (32.1%) and 38 no ACS (43.7%)] showing a high prevalence of coronary artery disease (CAD) [28 STEMI (96.6%), 9 NSTEMI (100.0%) and 26 no ACS (68.4%)] requiring percutaneous coronary intervention (PCI) in 52 cases [28 STEMI (96.6%), 8 NSTEMI (88.9%) and 16 no ACS (42.1%)]. Discussion: Coronary angiography immediately after hospital admission is feasible if all are prepared for potential further resuscitation efforts during cardiac catheterization. Primary focus on haemodynamic stabilisation may reduce the rates of coronary angiographies in patients following OHCA. Altogether, our data support the call for immediate coronary angiography in all patients following OHCA irrespective of their initial laboratory or electrocardiographic findings.

Early computed tomography in victims of non-traumatic out-of-hospital cardiac arrest

“…These numbers on their own demonstrate that early CT following OHCA is only performed in a small percentage of all victims of OHCA who are stable enough to endure complex diagnostic procedures. Of course, early procedures in patients following OHCA always require an awareness of the possible need for further resuscitation efforts, but our study results suggest that the small number of CT following OHCA might, therefore, be less associated with worry about hemodynamic stability than about the potential consequences of coronary preselection; higher rates of coronary angiographies but comparable rates of percutaneous coronary interventions in the group of patients examined by CT suggest that those patients who received coronary angiography without relevant coronary stenosis, in particular, were examined by CT (Table 2) [9]. In a reverse conclusion, we assume that the decision to perform diagnostic CT is less affected by the hemodynamic situation than by whether or not the coronary status sufficiently explains the cause of arrest.…”