Abstract
BackgroundCoronary artery disease (CAD) is the most common cause of sudden cardiac arrest (SCA). Although coronary angiography (CAG) should be performed also in the absence of ST-elevation (STE) after sustained return of spontaneous circulation (ROSC), this recommendation is not well implemented in daily routine.MethodsA retrospective database analysis was conducted in a tertiary care center between January 2005 and December 2014. We included all SCA patients aged ≥ 18 years with presumed cardiac cause and sustained ROSC in the absence of STE at hospital admission. The rate and timing of CAG were defined as the primary endpoints. As secondary endpoints, the reasons pro and contra CAG were analyzed. Furthermore, we observed if the signs and symptoms used for decision making occurred more often in patients with treatable CAD.ResultsWe included 645 (53.6%) of the 1203 screened patients, CAG was performed in 343 (53.2%) patients with a diagnosis of occlusive CAD in 214 (62.4%) patients. Of these, 151 (71.0%) patients had occlusive CAD treated with coronary intervention, thrombus aspiration, or coronary artery bypass grafting. In an adjusted binomial logistic regression analysis, age ≥ 70 years, female sex, non-shockable rhythms, and cardiomyopathy were associated with withholding of CAG. In patients diagnosed and treated with occlusive CAD, initially shockable rhythms, previously diagnosed CAD, hypertension, and smoking were found more often.ConclusionAlthough selection bias is unavoidable due to the retrospective design of this study, a high proportion of the examined patients had occlusive CAD. The criteria used for patient selection may be suboptimal.
Highlights
Sudden cardiac arrest (SCA) is one of the leading causes of death, affecting up to 700,000 individuals in Europe every year [1]
Based on the reports of interventional cardiologists, we stratified our collective into three groups: coronary angiography (CAG), no occlusive Coronary artery disease (CAD), CAG, occlusive CAD and no CAG examination
A CAG was performed in 343 (53.2%) patients with a subsequent diagnosis of occlusive CAD in 214 (62.4%) patients; of these, in 151 (71.0%) patients occlusive CAD was treated with percutaneous coronary intervention (PCI), thrombus aspiration or CABG (Fig. 1)
Summary
Sudden cardiac arrest (SCA) is one of the leading causes of death, affecting up to 700,000 individuals in Europe every year [1]. Immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI), if appropriate, should be a substantial part of standardized postresuscitation care [3]. Emergent CAG for resuscitated patients with ST-elevation (STE) myocardial infarction is recommended and leads to both increased survival and improved neurological outcomes [4]. The approach concerning CAG for patients after SCA in the absence of STE remains unclear because of conflicting data. While some studies have associated early CAG ± PCI with decreased mortality [5, 6], other studies could not show this effect [7,8,9,10]
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