Abstract
Out-of-hospital cardiac arrest (OHCA) is a major cause of death. Although the aetiology of cardiac arrest can be diverse, the most common cause is ischaemic heart disease. Coronary angiography and percutaneous coronary intervention, if indicated, has been associated with improved long-term survival for patients with initial shockable rhythm. However, in patients without ST-segment elevation on the post-resuscitation electrocardiogram, the optimal timing of performing this invasive procedure is uncertain. One important challenge that clinicians face is to appropriately select patients that will benefit from immediate coronary angiography, yet avoid unnecessary delay of intensive care support and targeted temperature management. Observational studies have reported contradictory results and until recently, randomised trials were lacking. The Coronary Angiography after Cardiac Arrest without ST-segment elevation (COACT) was the first randomised trial that provided comparative information between coronary angiography treatment strategies. This literature review will provide the current knowledge and gaps in the literature regarding optimal care for patients successfully resuscitated from OHCA in the absence of ST-segment elevation and will primarily focus on the role and timing of coronary angiography in this high-risk patient population.
Highlights
Out-of-hospital cardiac arrest (OHCA) is a major cause of death [1, 2]
Numerous observational studies have investigated the effect of early coronary angiography in cardiac arrest patients without segment elevation (STE) [13, 25,26,27] with conflicting outcomes
The multicentre randomised COACT trial found that a strategy of immediate angiography was not better than delayed coronary angiography with respect to 90-day survival
Summary
Neth Heart J (2020) 28 (Suppl 1):S108–S114 https://doi.org/10.1007/s12471-020-01460-8 The role of coronary angiography in out-of-hospital cardiac arrest patients in the absence of ST-segment elevation: A literature review E. M. Spoormans · J. S. Lemkes · G. N. Janssens · N. W. van der Hoeven · J. L. Bonnes · N. van Royen
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More From: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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