Optimal timing of coronary intervention in patients resuscitated from cardiac arrest without ST-segment elevation myocardial infarction (NSTEMI): A systematic review and meta-analysis

Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest

“…On the other hand, the need for urgent coronary angiography is controversial in the absence of STEMI because the survival is similar regardless of an invasive or delayed approach. 23,24 In light of these results, we believe that the precise diagnosis of STEMI is important for the correct management of patients who are resuscitated from OHCA and for the precise identification of patients for whom an urgent coronary angiography could be beneficial. However, the European Resuscitation Council, American Heart Association, and European Society of Cardiology guidelines, although stressing the key role of the ECG acquisition after ROSC, do not establish the timing for this.…”

“…To our knowledge, none of the studies on the immediate or delayed performance of coronary angiography after ROSC has considered the timing of ECG acquisition, which given the results of the present study, may have influenced the results of those studies. [16][17][18][19][20][21][22][23][24] A percentage of patients with false-positive ECG findings (ie, patients who had ECG findings that met STEMI criteria but who did not require PTCA) could have experienced a myocardial infarction with nonobstructive coronary arteries. However, given that this is diagnosed in a small percentage of patients with acute myocardial infarction (approximately 6%) 28 and that such cases would have been evenly distributed in the 3 tertiles of the ROSC to ECG time, it is reasonable to assume that myocardial infarction with nonobstructive coronary arteries did not affect our results.…”

Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020

“…Optimal timing for cardiac catheterization after cardiac arrest remains controversial in patients without ST‐segment elevation 36,37 . A meta‐analysis found no improvement in outcomes despite shorter intervals to catheterization after arrest, which comports with the relatively low percentage of intervenable lesions for non‐ST‐segment elevation arrests identified in the COACT trial 36 .…”

Kreislaufstillstand unter besonderen Umständen

“…Bei Patienten mit ROSC- und fehlenden STEMI-Kriterien berichteten zwei systematische Übersichten über Vorteile der Durchführung einer PCI [ 268 , 269 ], allerdings bleibt der Zeitpunkt der Koronarangiographie weiterhin umstritten. Die COACT-Studie zeigte keinen Nutzen der direkten im Vergleich zur verzögerten Koronarangiographie im 90-Tage-Überleben bei solchen Patienten mit anfänglich schockbarem Rhythmus und ohne STEMI oder einer anderen nichtkardialen Ursache für OHCA, die nach ROSC bewusstlos blieben [ 270 ].…”