Abstract 186: Coronary Angiographic Findings in Patients with or Without ST-Segment Elevation Resuscitated After Out-of-Hospital Cardiac Arrest

Abstract

Background: Long-term survival after out-of-hospital cardiac arrest (OHCA) has improved in the last decade with special focus on the post cardiac arrest syndrome. Therapeutic hypothermia and percutaneous coronary intervention (PCI) are the two most important in-hospital interventions. International guidelines recommend aggressive use of coronary angiography in patients with ST segment elevation myocardial infarction (STEMI), but it is not clear if also patients without ST elevation should undergo early coronary angiography (ECA). The aim of the study was to document outcome in all OHCA patients of cardiac etiology, with special focus on angiographic findings and survival among patients with or without ST segment elevation. Methods: All patients admitted to our hospital after primary resuscitated OHCA are registered in our Post-resuscitation care registry. Electrocardiogram (ECG), coronary angiographic findings and overall survival of patients admitted in 2008 with cardiac etiology were investigated retrospectively by reviewing medical charts. Patients were classified according to the presence of ST segment elevation on post-resuscitation ECG or not. Results: Altogether 62 patients were included. ST elevation was present in 33 (53%) patients in whom all underwent ECA, 24 (73%) had an acute coronary occlusion, 5 (15%) had old occlusions, 17 (51%) had multivessel disease, and 29 (88%) received PCI. Among the 29 (47%) patients without ST elevation, 24 (83%) underwent ECA, of whom 5 (17%) had an acute coronary occlusion, 12 (50%) had old occlusions, 18 (75%) had multivessel disease, and 12 (38%) received PCI. In total, 60% of the patients were treated with therapeutic hypothermia with no difference between the two groups. Overall survival was 64% and 59% in patients with and without ST elevation, respectively (ns). Conclusion: Overall survival after OHCA of cardiac etiology was good, with no difference between patients with or without ST segment elevation. The presence of ST elevation on ECG was highly associated with the presence of an acute coronary occlusion, but a substantial proportion of patients without ST elevation also had coronary occlusions treated by PCI and more studies are warranted to determine whether all patients should undergo ECA.