Immediate Coronary Angiography in Survivors of Out-of-Hospital Cardiac Arrest

TLDR

The incidence of acute coronary‑artery occlusion in patients who suffer sudden cardiac arrest outside the hospital is unknown, and the benefit of reperfusion therapy has not been established. The study aimed to evaluate the prevalence of coronary occlusion and the impact of immediate coronary angiography and angioplasty on survival in survivors of out‑of‑hospital cardiac arrest. Eighty‑four consecutive patients aged 30–75 without obvious non‑cardiac causes underwent coronary angiography between 1994 and 1996, with angioplasty performed when indicated. Among the 84 patients, 48 % had coronary‑artery occlusion; angioplasty was technically successful in 28 of 37 attempts, and successful angioplasty independently predicted in‑hospital survival (OR 5.2, 95 % CI 1.1–24.5), with an overall survival rate of 38 % despite poor clinical and ECG predictors.

Abstract

The incidence of acute coronary-artery occlusion among patients with sudden cardiac arrest outside of the hospital is unknown, and the role of reperfusion therapy has not been determined. We therefore performed immediate coronary angiography and angioplasty when indicated in survivors of out-of-hospital cardiac arrest.Between September 1994 and August 1996, coronary angiography was performed in 84 consecutive patients between the ages of 30 and 75 years who had no obvious noncardiac cause of cardiac arrest.Sixty of the 84 patients had clinically significant coronary disease on angiography, 40 of whom had coronary-artery occlusion (48 percent). Angioplasty was attempted in 37 patients and was technically successful in 28. Clinical and electrocardiographic findings, such as the occurrence of chest pain and the presence of ST-segment elevation, were poor predictors of acute coronary-artery occlusion. The in-hospital survival rate was 38 percent. Multivariate logistic-regression analysis revealed that successful angioplasty was an independent predictor of survival (odds ratio, 5.2; 95 percent confidence interval, 1.1 to 24.5; P=0.04).Acute coronary-artery occlusion is frequent in survivors of out-of-hospital cardiac arrest and is predicted poorly by clinical and electrocardiographic findings. Accurate diagnosis by immediate coronary angiography can be followed in suitable candidates by coronary angioplasty, which seems to improve survival.