Early prognosis and predictor analysis for positive coronary angiography after out-of-hospital cardiac arrest (OHCA)

Abstract

Cardiac arrest occurring out of hospital carries a poor likelihood of overall survival. Key predictors of survival have been described in the literature. Current guidelines recommend emergency coronary angiography in patients without an obvious extra-cardiac cause of arrest. However, the prognostic value of this strategy is debated. Moreover, diagnosis of acute coronary ischemia after OHCA remains challenging, especially in patients without ST-segment elevation. Our aim was to identify qualitative variables associated with 30-day survival after OHCA. Afterwards, we sought to determine if coronary angiography was associated with better outcome and to identify predictors for a positive angiography in patients without ST-segment elevation. This is a retrospective single-center study that investigated data from a consecutive series of 123 patients admitted to our emergency department (ED) with resuscitated OHCA (2012–2014). Baseline characteristics, resuscitation settings and angiographic findings were analyzed. Convertible cardiac rhythm, witnessed status, acute coronary syndrome (ACS), ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and coronary angiography were associated with an increased chance of 30-day survival. Among patients without ST-segment elevation, predictors for a positive angiography included history of coronary disease, age, gender, diabetes, dyslipidemia and presence of at least two cardiovascular risk factors ( Table 1 , Fig. 1 ). We identified qualitative predictors for 30-day survival after OHCA. Diagnosis of ACS and coronary angiography were associated with a better outcome. Among patients without ST-segment elevation, the identification of risk factors may help to select the best candidates for emergency angiography. These findings suggest that the recognition of acute coronary ischemia after OHCA might be improved. Parameters associated with coronary artery disease in patients with cardiac etiology and absence of ST-segment elevation.