Part 5: Acute Coronary Syndromes

Νικολάου, Νικόλαος; Welsford, Michelle; Beygui, Farzin; Bossaert, Leo; Ghaemmaghami, Chris A.; Nonogi, Hiroshi; O’Connor, Robert E.; Pichel, Daniel; Scott, Tony; Walters, D.; Woolfrey, Karen

doi:10.1161/cir.0000000000000274

Cited by 59 publications

(15 citation statements)

References 119 publications

(107 reference statements)

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“…Where transport times are more than 30 to 60 minutes, the time advantage conferred by prehospital fibrinolysis provides a mortality benefit. 4 This benefit from prehospital fibrinolysis was found consistently by 3 RCTs performed more than 20 years ago. [61][62][63] However, these studies were performed at a time when hospital fibrinolytic administration typically took well in excess of 60 minutes.…”

Section: Evidence Summarymentioning

confidence: 79%

“…4 Prehospital activation of the catheterization laboratory (as opposed to delaying cardiac catheterization laboratory activation until the patient arrives at the hospital) is independently associated with improved times to PPCI and reduced mortality. 4 Prehospital ECG acquisition and hospital notification reduce mortality by 32% when PPCI is the reperfusion strategy (benefit is accentuated when prehospital activation occurs) and by 24% when ED fibrinolysis is the reperfusion strategy. 4 …”

Section: Evidence Summarymentioning

confidence: 99%

“…4 Prehospital ECG acquisition and hospital notification reduce mortality by 32% when PPCI is the reperfusion strategy (benefit is accentuated when prehospital activation occurs) and by 24% when ED fibrinolysis is the reperfusion strategy. 4 …”

Section: Evidence Summarymentioning

confidence: 99%

“…Prehospital fibrinolysis requires a sophisticated system of provider expertise, well-established protocols, comprehensive training programs, medical oversight, and quality assurance. 4 In many European systems, a physician provides prehospital fibrinolysis, but nonphysicians can also safely administer fibrinolytics. 60 The 2015 ILCOR systematic review evaluated whether prehospital fibrinolysis is preferred to reperfusion inhospital where the prehospital fibrinolysis expertise, education, and system support exists.…”

Section: Reperfusion Decisions In Stemi Patientsmentioning

confidence: 99%

“…The 3,4 In this in-depth evidence review process, ILCOR examined topics and then generated a prioritized list of questions for systematic review. Questions were first formulated in PICO (population, intervention, comparator, outcome) format, 5 and then a search for relevant articles was performed.…”

Section: Introductionmentioning

confidence: 99%

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Part 9: Acute Coronary Syndromes

O’Connor¹,

Ali²,

Brady³

et al. 2015

Circulation

Self Cite

103

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show abstract

Section: Evidence Summarymentioning

confidence: 79%

Section: Evidence Summarymentioning

confidence: 99%

Section: Evidence Summarymentioning

confidence: 99%

Section: Reperfusion Decisions In Stemi Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Part 9: Acute Coronary Syndromes

O’Connor¹,

Ali²,

Brady³

et al. 2015

Circulation

Self Cite

103

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show abstract

ST‐Segment Elevation Myocardial Infarction

2022

Practical Cardiovascular Medicine

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Evaluation of factors associated with selection for coronary angiography and in‐hospital mortality among patients presenting with out‐of‐hospital cardiac arrest without ST‐segment elevation

Zheng

Noaman

Hanson

et al. 2022

Cathet Cardio Intervent

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Background Clinical factors favouring coronary angiography (CA) selection and variables associated with in‐hospital mortality among patients presenting with out‐of‐hospital cardiac arrest (OHCA) without ST‐segment elevation (STE) remain unclear. Methods We evaluated clinical characteristics associated with CA selection and in‐hospital mortality in patients with OHCA, shockable rhythm and no STE. Results Between 2014 and 2018, 118 patients with OHCA and shockable rhythm without STE (mean age 59; males 75%) were stratified by whether CA was performed. Of 86 (73%) patients undergoing CA, 30 (35%) received percutaneous coronary intervention (PCI). CA patients had shorter return of spontaneous circulation (ROSC) time (17 vs. 25 min) and were more frequently between 50 and 60 years (29% vs. 6.5%), with initial Glasgow Coma Scale (GCS) score >8 (24% vs. 6%) (all p < 0.05). In‐hospital mortality was 33% (n = 39) for overall cohort (CA 27% vs. no‐CA 50%, p = 0.02). Compared to late CA, early CA ( ≤ 2 h) was not associated with lower in‐hospital mortality (32% vs. 34%, p = 0.82). Predictors of in‐hospital mortality included longer defibrillation time (odds ratio 3.07, 95% confidence interval 1.44‒6.53 per 5‐min increase), lower pH (2.02, 1.33‒3.09 per 0.1 decrease), hypoalbuminemia (2.02, 1.03‒3.95 per 5 g/L decrease), and baseline renal dysfunction (1.33, 1.02‒1.72 per 10 ml/min/1.73 m2 decrease), while PCI to lesion (0.11, 0.01‒0.79) and bystander defibrillation (0.06, 0.004‒0.80) were protective factors (all p < 0.05). Conclusions Among patients with OHCA and shockable rhythm without STE, younger age, shorter time to ROSC and GCS >8 were associated with CA selection, while less effective resuscitation, greater burden of comorbidities and absence of treatable coronary lesion were key adverse prognostic predictors.

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Part 5: Acute Coronary Syndromes

Cited by 59 publications

References 119 publications

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

ST‐Segment Elevation Myocardial Infarction

Evaluation of factors associated with selection for coronary angiography and in‐hospital mortality among patients presenting with out‐of‐hospital cardiac arrest without ST‐segment elevation

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