Coronary angiographic and culprit lesion characteristics in patients resuscitated from out-of-hospital cardiac arrest

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Emergent coronary angiography is recommended in patients with return of spontaneous circulation (ROSC) after out of hospital cardiac arrest (OHCA) of suspected cardiac origin. The aim of this study was to analyze the prevalence of coronary artery disease (CAD), characteristics of the culprit lesions in case of acute coronary syndrome (ACS) and the success of percutaneous coronary intervention (PCI) in patients resuscitated from OHCA due to a shockable rhythm, i.e. ventricular fibrillation (VF) and ventricular tachycardia (VT). Methods We analyzed the data of 150 patients in whom coronary angiography was performed in the setting of ROSC after OHCA. Patients were categorized to have non obstructive CAD or obstructive CAD. Patients with obstructive CAD were classified as acute myocardial infarction (ST-elevation myocardial infarction (STEMI), Non-ST-elevation myocardial infarction (NSTEMI)) and chronic coronary syndrome. The culprit vessel was identified by means of electrocardiographic findings, echocardiography and coronary angiography. Coronary angiograms and all clinical data were reviewed in consensus by two experienced interventional cardiologists. Successful PCI was defined as angiographic restoration of TIMI III flow. Results Significant CAD was ruled out in 27 patients (18.0%). Obstructive CAD with at least one coronary artery stenosis was found in 123 patients (82.0%). According to clinical and angiographic findings, ACS was found in 105/150 patients (70.0%). Of the 105 patients with ACS, 53 (35.3%) presented with STEMI and 52 (34.7%) presented with NSTEMI. 18/123 patients (14.6%) showed chronic coronary syndrome. Among the patients with obstructive CAD, 1-vessel CAD was found in 32 patients (26.0%), 2-vessel CAD in 44 patients (35.8%), 3-vessel CAD in 47 patients (38.2%). 41 (33.3%) of the patients with CAD showed a chronic total occlusion (CTO) of at least one vessel. In patients presenting with ACS, the most common culprit vessels were LAD (37.4%) and CX (23.6%), followed by RCA (11.4%) and LM (2.4%). In 22.8% of the patients, the culprit vessel could not be unambiguously identified. In 82.9% of the patients with ACS/CAD, PCI was performed. TIMI flow after intervention was TIMI III in 92.1%, TIMI II in 3.9%, TIMI I in 2.0% and TIMI 0 in 2.0%. Conclusion In patients resuscitated from OHCA due to VF/VT, multivessel disease is common. Most frequently, culprit lesions are located in the LAD and CX. PCI in OHCA patients can be performed at a high success rate.