Outcomes of Comatose Cardiac Arrest Survivors with and Without ST-Segment Elevation Myocardial Infarction Importance of Coronary Angiography

INTCAR-Cardiology Registry

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Objectives The aim of this study was to compare outcomes and coronary angiographic findings in post-cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI). Background The 2013 STEMI guidelines recommend performing immediate angiography in resuscitated patients whose initial electrocardiogram shows STEMI. The optimal approach for those without STEMI post-cardiac arrest is less clear. Methods A retrospective evaluation of a post-cardiac arrest registry was performed. Results The database consisted of 746 comatose post-cardiac arrest patients including 198 with STEMI (26.5%) and 548 without STEMI (73.5%). Overall survival was greater in those with STEMI compared with those without (55.1% vs. 41.3%; p = 0.001), whereas in all patients who underwent immediate coronary angiography, survival was similar between those with and without STEMI (54.7% vs. 57.9%; p = 0.60). A culprit vessel was more frequently identified in those with STEMI, but also in one-third of patients without STEMI (80.2% vs. 33.2%; p = 0.001). The majority of culprit vessels were occluded (STEMI, 92.7%; no STEMI, 69.2%; p < 0.0001). An occluded culprit vessel was found in 74.3% of STEMI patients and in 22.9% of no STEMI patients. Among cardiac arrest survivors discharged from the hospital who had presented without STEMI, coronary angiography was associated with better functional outcome (93.3% vs. 78.7%; p < 0.003). Conclusions Early coronary angiography is associated with improved functional outcome among resuscitated patients with and without STEMI. Resuscitated patients with a presumed cardiac etiology appear to benefit from immediate coronary angiography.

Original languageEnglish (US)
Pages (from-to)1031-1040
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume8
Issue number8
DOIs
StatePublished - Jul 1 2015

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Coma
Heart Arrest
Coronary Angiography
Survivors
Myocardial Infarction
ST Elevation Myocardial Infarction
Survival
Registries
Angiography
Electrocardiography

Keywords

  • cardiac arrest
  • coronary angiography
  • hypothermia
  • post-resuscitation syndrome
  • STEMI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of Comatose Cardiac Arrest Survivors with and Without ST-Segment Elevation Myocardial Infarction Importance of Coronary Angiography. / INTCAR-Cardiology Registry.

In: JACC: Cardiovascular Interventions, Vol. 8, No. 8, 01.07.2015, p. 1031-1040.

Research output: Contribution to journalArticle

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title = "Outcomes of Comatose Cardiac Arrest Survivors with and Without ST-Segment Elevation Myocardial Infarction Importance of Coronary Angiography",
abstract = "Objectives The aim of this study was to compare outcomes and coronary angiographic findings in post-cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI). Background The 2013 STEMI guidelines recommend performing immediate angiography in resuscitated patients whose initial electrocardiogram shows STEMI. The optimal approach for those without STEMI post-cardiac arrest is less clear. Methods A retrospective evaluation of a post-cardiac arrest registry was performed. Results The database consisted of 746 comatose post-cardiac arrest patients including 198 with STEMI (26.5{\%}) and 548 without STEMI (73.5{\%}). Overall survival was greater in those with STEMI compared with those without (55.1{\%} vs. 41.3{\%}; p = 0.001), whereas in all patients who underwent immediate coronary angiography, survival was similar between those with and without STEMI (54.7{\%} vs. 57.9{\%}; p = 0.60). A culprit vessel was more frequently identified in those with STEMI, but also in one-third of patients without STEMI (80.2{\%} vs. 33.2{\%}; p = 0.001). The majority of culprit vessels were occluded (STEMI, 92.7{\%}; no STEMI, 69.2{\%}; p < 0.0001). An occluded culprit vessel was found in 74.3{\%} of STEMI patients and in 22.9{\%} of no STEMI patients. Among cardiac arrest survivors discharged from the hospital who had presented without STEMI, coronary angiography was associated with better functional outcome (93.3{\%} vs. 78.7{\%}; p < 0.003). Conclusions Early coronary angiography is associated with improved functional outcome among resuscitated patients with and without STEMI. Resuscitated patients with a presumed cardiac etiology appear to benefit from immediate coronary angiography.",
keywords = "cardiac arrest, coronary angiography, hypothermia, post-resuscitation syndrome, STEMI",
author = "{INTCAR-Cardiology Registry} and Kern, {Karl B} and Kapildeo Lotun and Nainesh Patel and Mooney, {Michael R.} and Hollenbeck, {Ryan D.} and McPherson, {John A.} and McMullan, {Paul W.} and Barbara Unger and Chiu-Hsieh Hsu and Seder, {David B.}",
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T1 - Outcomes of Comatose Cardiac Arrest Survivors with and Without ST-Segment Elevation Myocardial Infarction Importance of Coronary Angiography

AU - INTCAR-Cardiology Registry

AU - Kern, Karl B

AU - Lotun, Kapildeo

AU - Patel, Nainesh

AU - Mooney, Michael R.

AU - Hollenbeck, Ryan D.

AU - McPherson, John A.

AU - McMullan, Paul W.

AU - Unger, Barbara

AU - Hsu, Chiu-Hsieh

AU - Seder, David B.

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N2 - Objectives The aim of this study was to compare outcomes and coronary angiographic findings in post-cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI). Background The 2013 STEMI guidelines recommend performing immediate angiography in resuscitated patients whose initial electrocardiogram shows STEMI. The optimal approach for those without STEMI post-cardiac arrest is less clear. Methods A retrospective evaluation of a post-cardiac arrest registry was performed. Results The database consisted of 746 comatose post-cardiac arrest patients including 198 with STEMI (26.5%) and 548 without STEMI (73.5%). Overall survival was greater in those with STEMI compared with those without (55.1% vs. 41.3%; p = 0.001), whereas in all patients who underwent immediate coronary angiography, survival was similar between those with and without STEMI (54.7% vs. 57.9%; p = 0.60). A culprit vessel was more frequently identified in those with STEMI, but also in one-third of patients without STEMI (80.2% vs. 33.2%; p = 0.001). The majority of culprit vessels were occluded (STEMI, 92.7%; no STEMI, 69.2%; p < 0.0001). An occluded culprit vessel was found in 74.3% of STEMI patients and in 22.9% of no STEMI patients. Among cardiac arrest survivors discharged from the hospital who had presented without STEMI, coronary angiography was associated with better functional outcome (93.3% vs. 78.7%; p < 0.003). Conclusions Early coronary angiography is associated with improved functional outcome among resuscitated patients with and without STEMI. Resuscitated patients with a presumed cardiac etiology appear to benefit from immediate coronary angiography.

AB - Objectives The aim of this study was to compare outcomes and coronary angiographic findings in post-cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI). Background The 2013 STEMI guidelines recommend performing immediate angiography in resuscitated patients whose initial electrocardiogram shows STEMI. The optimal approach for those without STEMI post-cardiac arrest is less clear. Methods A retrospective evaluation of a post-cardiac arrest registry was performed. Results The database consisted of 746 comatose post-cardiac arrest patients including 198 with STEMI (26.5%) and 548 without STEMI (73.5%). Overall survival was greater in those with STEMI compared with those without (55.1% vs. 41.3%; p = 0.001), whereas in all patients who underwent immediate coronary angiography, survival was similar between those with and without STEMI (54.7% vs. 57.9%; p = 0.60). A culprit vessel was more frequently identified in those with STEMI, but also in one-third of patients without STEMI (80.2% vs. 33.2%; p = 0.001). The majority of culprit vessels were occluded (STEMI, 92.7%; no STEMI, 69.2%; p < 0.0001). An occluded culprit vessel was found in 74.3% of STEMI patients and in 22.9% of no STEMI patients. Among cardiac arrest survivors discharged from the hospital who had presented without STEMI, coronary angiography was associated with better functional outcome (93.3% vs. 78.7%; p < 0.003). Conclusions Early coronary angiography is associated with improved functional outcome among resuscitated patients with and without STEMI. Resuscitated patients with a presumed cardiac etiology appear to benefit from immediate coronary angiography.

KW - cardiac arrest

KW - coronary angiography

KW - hypothermia

KW - post-resuscitation syndrome

KW - STEMI

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