1
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Spoormans EM, Lemkes JS, Janssens GN, van der Hoeven NW, Jewbali LS, Dubois EA, Meuwissen M, Rijpstra TA, Bosker HA, Blans MJ, Bleeker GB, Baak R, Vlachojannis GJ, Eikemans BJ, van der Harst P, van der Horst IC, Voskuil M, van der Heijden JJ, Beishuizen A, Stoel M, Camaro C, van der Hoeven H, Henriques JP, Vlaar AP, Vink MA, van den Bogaard B, Heestermans TA, de Ruijter W, Delnoij TS, Crijns HJ, Oemrawsingh PV, Gosselink MT, Plomp K, Magro M, Elbers PW, van der Pas S, van Royen N. The Prognostic Value of Troponin-T in Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: A COACT Substudy. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101191. [PMID: 39132217 PMCID: PMC11308418 DOI: 10.1016/j.jscai.2023.101191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 08/13/2024]
Abstract
Background In out-of-hospital cardiac arrest (OHCA) without ST-elevation, predictive markers that can identify those with a high risk of acute coronary syndrome are lacking. Methods In this post hoc analysis of the Coronary Angiography after Cardiac Arrest (COACT) trial, the baseline, median, peak, and time-concentration curves of troponin-T (cTnT) (T-AUC) in OHCA patients without ST-elevation were studied. cTnT values were obtained at predefined time points at 0, 3, 6, 12, 24, 36, 28, and 72 hours after admission. All patients who died within the measurement period were not included. The primary outcome was the association between cTnT and 90-day survival. Secondary outcomes included the association of cTnT and acute thrombotic occlusions, acute unstable lesions, and left ventricular function. Results In total, 352 patients were included in the analysis. The mean age was 64 ± 13 years (80.4% men). All cTnT measures were independent prognostic factors for mortality after adjustment for potential confounders age, sex, history of coronary artery disease, witnessed arrest, time to BLS, and time to return of spontaneous circulation (eg, for T-AUC: hazard ratio, 1.44; 95% CI, 1.06-1.94; P = .02; P value for all variables ≤.02). Median cTnT (odds ratio [OR], 1.58; 95% CI, 1.18-2.12; P = .002) and T-AUC (OR, 2.03; 95% CI, 1.25-3.29; P = .004) were independent predictors for acute unstable lesions. Median cTnT (OR, 1.62; 95% CI, 1.17-2.23; P = .003) and T-AUC (OR, 2.16; 95% CI, 1.27-3.68; P = .004) were independent predictors for acute thrombotic occlusions. CTnT values were not associated with the left ventricular function (eg, for T-AUC: OR, 2.01; 95% CI, 0.65-6.19; P = .22; P value for all variables ≥.14). Conclusion In OHCA patients without ST-segment elevation, cTnT release during the first 72 hours after return of spontaneous circulation was associated with clinical outcomes.
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Affiliation(s)
- Eva M. Spoormans
- Department of Cardiology, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Jorrit S. Lemkes
- Department of Cardiology, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Gladys N. Janssens
- Department of Cardiology, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Nina W. van der Hoeven
- Department of Cardiology, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Lucia S.D. Jewbali
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eric A. Dubois
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Tom A. Rijpstra
- Department of Intensive Care Medicine, Amphia Hospital, Breda, the Netherlands
| | - Hans A. Bosker
- Department of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michiel J. Blans
- Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Gabe B. Bleeker
- Department of Cardiology, HAGA Hospital, Den Haag, the Netherlands
| | - Remon Baak
- Department of Intensive Care Medicine, HAGA Hospital, Den Haag, the Netherlands
| | - Georgios J. Vlachojannis
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bob J.W. Eikemans
- Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Iwan C.C. van der Horst
- Department of Intensive Care Medicine, University Medical Center Groningen, Groningen, the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joris J. van der Heijden
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Martin Stoel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Cyril Camaro
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hans van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - José P. Henriques
- Department of Cardiology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Alexander P.J. Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | | | | | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Noord West Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Thijs S.R. Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Harry J.G.M. Crijns
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Koos Plomp
- Department of Cardiology, Tergooi Hospital, Blaricum, the Netherlands
| | - Michael Magro
- Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Paul W.G. Elbers
- Department of Intensive Care Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Stéphanie van der Pas
- Epidemiology and Data Science, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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2
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Yoshimura S, Kiguchi T, Irisawa T, Yamada T, Yoshiya K, Park C, Nishimura T, Ishibe T, Kobata H, Kishimoto M, Kim SH, Ito Y, Sogabe T, Morooka T, Sakamoto H, Suzuki K, Onoe A, Matsuyama T, Matsui S, Nishioka N, Okada Y, Makino Y, Kimata S, Kawai S, Zha L, Kiyohara K, Kitamura T, Iwami T. Diagnostic test accuracy of life-threatening electrocardiographic findings (ST-elevation myocardial infarction equivalents) for acute coronary syndrome after out-of-hospital cardiac arrest without ST-segment elevation. Resuscitation 2023; 184:109700. [PMID: 36702338 DOI: 10.1016/j.resuscitation.2023.109700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/04/2023] [Accepted: 01/15/2023] [Indexed: 01/25/2023]
Abstract
AIM Life-threatening electrocardiographic (ECG) findings aid in the diagnosis of acute coronary syndrome (ACS), which has not been well-evaluated in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the diagnostic test accuracy (DTA) of ST-elevation myocardial infarction (STEMI) equivalents following the return of spontaneous circulation (ROSC) in patients with OHCA to identify patients with ACS. METHODS Using the database of the Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival study from 2012 to 2017, patients aged ≥18 years with non-traumatic OHCA and ventricular fibrillation or pulseless ventricular tachycardia on the arrival of emergency medical service personnel or arrival at the emergency department, who achieved ROSC, were included. Patients without ST-segment elevation or complete left bundle branch block on ECG and those who did not undergo ECG or coronary angiography, were excluded from the study. We evaluated the DTA of STEMI equivalents for the diagnosis of ACS: isolated T-wave inversion, ST-segment depression, Wellens' signs, and ST-segment elevation in lead aVR. RESULTS Isolated T-wave inversion and Wellens' signs had high specificity for ACS with 0.95 (95% confidence interval [CI], 0.87-0.99) and 0.92 (95% CI, 0.82-0.97), respectively, but their positive likelihood ratios were low, with a wide range of 95% CI: 1.89 (95% CI, 0.51-7.02) and 0.81 (95% CI, 0.25-2.68), respectively. CONCLUSION The DTA of STEMI equivalents for the diagnosis of ACS was low among patients with OHCA. Further investigation considering the measurement timing of the ECG after ROSC is required.
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Affiliation(s)
- Satoshi Yoshimura
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeyuki Kiguchi
- Critical Care and Trauma Centre, Osaka General Medical Centre, Osaka, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Yamada
- Emergency and Critical Care Medical Centre, Osaka Police Hospital, Osaka, Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan
| | - Changhwi Park
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Tetsuro Nishimura
- Department of Critical Care Medicine, Osaka City University, Osaka, Japan
| | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine, Kindai University School of Medicine, Osaka-Sayama, Japan
| | - Hitoshi Kobata
- Osaka Mishima Emergency Critical Care Centre, Takatsuki, Japan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Centre of Acute Medicine, Higashi-Osaka, Japan
| | - Sung-Ho Kim
- Senshu Trauma and Critical Care Centre, Osaka, Japan
| | - Yusuke Ito
- Senri Critical Care Medical Centre, Saiseikai Senri Hospital, Suita, Japan
| | - Taku Sogabe
- Traumatology and Critical Care Medical Centre, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takaya Morooka
- Emergency and Critical Care Medical Centre, Osaka City General Hospital, Osaka, Japan
| | - Haruko Sakamoto
- Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan
| | - Keitaro Suzuki
- Emergency and Critical Care Medical Centre, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Yohei Okada
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Yuto Makino
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Shunsuke Kimata
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Shunsuke Kawai
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.
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3
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Spoormans EM, Lemkes JS, Janssens GN, Soultana O, van der Hoeven NW, Jewbali LSD, Dubois EA, Meuwissen M, Rijpstra TA, Bosker HA, Blans MJ, Bleeker GB, Baak R, Vlachojannis GJ, Eikemans BJW, van der Harst P, van der Horst ICC, Voskuil M, van der Heijden JJ, Beishuizen A, Stoel M, Camaro C, van der Hoeven H, Henriques JP, Vlaar APJ, Vink MA, van den Bogaard B, Heestermans TACM, de Ruijter W, Delnoij TSR, Crijns HJGM, Oemrawsingh PV, Gosselink MTM, Plomp K, Magro M, Elbers PWG, van de Ven PM, van Royen N. Ischaemic electrocardiogram patterns and its association with survival in out-of-hospital cardiac arrest patients without ST-segment elevation myocardial infarction: a COACT trials’ post-hoc subgroup analysis. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:535-543. [PMID: 35656797 PMCID: PMC9302930 DOI: 10.1093/ehjacc/zuac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022]
Abstract
Aims ST-depression and T-wave inversion are frequently present on the post-resuscitation electrocardiogram (ECG). However, the prognostic value of ischaemic ECG patterns is unknown. Methods and results In this post-hoc subgroup analysis of the Coronary Angiography after Cardiac arrest (COACT) trial, the first in-hospital post-resuscitation ECG in out-of-hospital cardiac arrest patients with a shockable rhythm was analysed for ischaemic ECG patterns. Ischaemia was defined as ST-depression of ≥0.1 mV, T-wave inversion in ≥2 contiguous leads, or both. The primary endpoint was 90-day survival. Secondary endpoints were rate of acute unstable lesions, levels of serum troponin-T, and left ventricular function. Of the 510 out-of-hospital cardiac arrest patients, 340 (66.7%) patients had ischaemic ECG patterns. Patients with ischaemic ECG patterns had a worse 90-day survival compared with those without [hazard ratio 1.51; 95% confidence interval (CI) 1.08–2.12; P = 0.02]. A higher sum of ST-depression was associated with lower survival (log-rank = 0.01). The rate of acute unstable lesions (14.5 vs. 15.8%; odds ratio 0.90; 95% CI 0.51–1.59) did not differ between the groups. In patients with ischaemic ECG patterns, maximum levels of serum troponin-T (μg/L) were higher [0.595 (interquartile range 0.243–1.430) vs. 0.359 (0.159–0.845); ratio of geometric means 1.58; 1.13–2.20] and left ventricular function (%) was worse (44.7 ± 12.5 vs. 49.9 ± 13.3; mean difference −5.13; 95% CI −8.84 to −1.42). Adjusted for age and time to return of spontaneous circulation, ischaemic ECG patterns were no longer associated with survival. Conclusion Post-arrest ischaemic ECG patterns were associated with worse 90-day survival. A higher sum of ST-depression was associated with lower survival. Adjusted for age and time to return of spontaneous circulation, ischaemic ECG patterns were no longer associated with survival.
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Affiliation(s)
- Eva M Spoormans
- Department of Cardiology, Amsterdam University Medical Centre , location VUmc, ZH 5F 19, De Boelelaan 1117, 1081 HV Amsterdam , The Netherlands
| | - Jorrit S Lemkes
- Department of Cardiology, Amsterdam University Medical Centre , location VUmc, ZH 5F 19, De Boelelaan 1117, 1081 HV Amsterdam , The Netherlands
| | - Gladys N Janssens
- Department of Cardiology, Amsterdam University Medical Centre , location VUmc, ZH 5F 19, De Boelelaan 1117, 1081 HV Amsterdam , The Netherlands
| | - Ouissal Soultana
- Department of Cardiology, Amsterdam University Medical Centre , location VUmc, ZH 5F 19, De Boelelaan 1117, 1081 HV Amsterdam , The Netherlands
| | - Nina W van der Hoeven
- Department of Cardiology, Amsterdam University Medical Centre , location VUmc, ZH 5F 19, De Boelelaan 1117, 1081 HV Amsterdam , The Netherlands
| | - Lucia S D Jewbali
- Department of Cardiology, Erasmus Medical Centre , Rotterdam , The Netherlands
| | - Eric A Dubois
- Department of Cardiology, Erasmus Medical Centre , Rotterdam , The Netherlands
- Department of Intensive Care Medicine, Erasmus Medical Centre , Rotterdam , The Netherlands
| | | | - Tom A Rijpstra
- Department of Intensive Care Medicine, Amphia Hospital , Breda , The Netherlands
| | - Hans A Bosker
- Department of Cardiology, Rijnstate Hospital , Arnhem , The Netherlands
| | - Michiel J Blans
- Department of Intensive Care Medicine, Rijnstate Hospital , Arnhem , The Netherlands
| | - Gabe B Bleeker
- Department of Cardiology, HAGA Hospital , Den Haag , The Netherlands
| | - Remon Baak
- Department of Intensive Care Medicine, HAGA Hospital , Den Haag , The Netherlands
| | - Georgios J Vlachojannis
- Department of Cardiology, Maasstad Hospital , Rotterdam , The Netherlands
- Department of Cardiology, University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Bob J W Eikemans
- Department of Intensive Care Medicine, Maasstad Hospital , Rotterdam , The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Centre Utrecht , Utrecht , The Netherlands
- Department of Cardiology, University of Groningen, University Medical Centre Groningen , Groningen , The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, University of Groningen, University Medical Centre Groningen , Groningen , The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre, University Maastricht , Maastricht , The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Joris J van der Heijden
- Department of Intensive Care Medicine, University Medical Centre Utrecht , Utrecht , The Netherlands
| | | | - Martin Stoel
- Department of Cardiology, Medisch Spectrum Twente , Enschede , The Netherlands
| | - Cyril Camaro
- Department of Cardiology, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Hans van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - José P Henriques
- Department of Cardiology, Amsterdam University Medical Centre , location AMC, Amsterdam , The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Centre , location AMC, Amsterdam , The Netherlands
| | - Maarten A Vink
- Department of Cardiology, OLVG , Amsterdam , The Netherlands
| | | | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Noord West Ziekenhuisgroep , Alkmaar , The Netherlands
| | - Thijs S R Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Centre, University Maastricht , Maastricht , The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | | | | | - Koos Plomp
- Department of Cardiology, Tergooi Hospital , Blaricum , The Netherlands
| | - Michael Magro
- Department of Cardiology, Elisabeth-Tweesteden Hospital , Tilburg , The Netherlands
| | - Paul W G Elbers
- Department of Intensive care medicine, Amsterdam University Medical Centre , location VUmc, Amsterdam , The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre , location VUmc, Amsterdam , The Netherlands
| | - Niels van Royen
- Department of Cardiology, Amsterdam University Medical Centre , location VUmc, ZH 5F 19, De Boelelaan 1117, 1081 HV Amsterdam , The Netherlands
- Department of Cardiology, Radboud University Medical Centre , Nijmegen , The Netherlands
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4
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Delbaere Q, Akodad M, Roubille F, Lattuca B, Cayla G, Leclercq F. One-Year Follow-Up of Patients Admitted for Emergency Coronary Angiography after Resuscitated Cardiac Arrest. J Clin Med 2022; 11:jcm11133738. [PMID: 35807020 PMCID: PMC9267145 DOI: 10.3390/jcm11133738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Despite the improvement of the in-hospital survival rate after aborted sudden cardiac death (SCD), cerebral anoxia may have severe neurologic consequences and may impair long-term outcome and quality of life of surviving patients. The aim of this study was to assess neurological outcomes at one year after resuscitated cardiac arrest; (2) Methods: This prospective, observational, and multicentre study included patients >18 yo admitted in the catheterisation laboratory for coronary angiography after aborted SCD between 1 May 2018 and 31 May 2020. Only patients who were discharged alive from hospital were evaluated. The primary endpoint was survival without neurological sequelae at one-year follow-up defined by a cerebral performance category (CPC) of one or two. Secondary end points included all-cause mortality, New York Heart Association (NYHA) functional class, neurologic evaluation at discharge, three-month and one-year follow-up using the CPC scale, and quality of life at 1 year using the Quality of Life after Brain Injury (QOLIBRI) questionnaire; (3) Results: Among 143 patients admitted for SCD within the study period, 61 (42.7%) were discharged alive from hospital, among whom 55 (90.1%) completed the one-year follow-up. No flow and low flow times were 1.9 ± 2.4 min and 16.5 ± 10.4 min, respectively. For 93.4% of the surviving patients, an initial shockable rhythm (n = 57) was observed and acute coronary syndrome was diagnosed in 75.4% of them (n = 46). At 1 year, survival rate without neurologic sequelae was 87.2% (n = 48). Patients with poor outcome were older (69.3 vs. 57.4 yo; p = 0.04) and had lower body mass index (22.4 vs. 26.7; p = 0.013) and a lower initial Left Ventricle Ejection Fraction (LVEF) (32.1% vs. 40.3%; p = 0.046). During follow-up, neurological status improved in 36.8% of patients presenting sequelae at discharge, and overall quality of life was satisfying for 66.7% of patients according to the QOLIBRI questionnaire; (4) Conclusions: Among patients admitted to the catheterisation laboratory for aborted SCD, mainly related to Acute Coronary Syndrom (ACS), less than a half of them were alive at discharge. However, the one-year survival rate without neurological sequelae was high and overall quality of life was good.
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Affiliation(s)
- Quentin Delbaere
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
- Correspondence:
| | - Myriam Akodad
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
| | - François Roubille
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
| | - Benoît Lattuca
- Department of Cardiology, Caremeau University Hospital, 30900 Nîmes, France; (B.L.); (G.C.)
| | - Guillaume Cayla
- Department of Cardiology, Caremeau University Hospital, 30900 Nîmes, France; (B.L.); (G.C.)
| | - Florence Leclercq
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
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5
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Abstract
PURPOSE OF REVIEW Early coronary angiogram (CAG) remains a cornerstone in postcardiac arrest management as coronary disease (CAD)-related cardiac arrest is the leading cause of sudden death in adults. The opportunity to treat the cause early on with immediate CAG may improve outcome in cardiac arrest patients with AMI. Identifying the patients who will benefit from such an early invasive strategy is an unanswered question. Recent and ongoing trials may improve the level of evidence on this problematic, especially for some subgroup; however, current guidelines remain founded upon a very heterogeneous level of evidence. RECENT FINDINGS The key variable to argue for immediate CAD remains the pattern of the ECG monitored after return of spontaneous of circulation (ROSC). ST-segment elevation (STE) on postresuscitation ECG is the strongest argument to rule for an early CAG strategy. In other situations, identifying the best candidates for early CAG is very challenging. Different approaches including elements, such as circumstances of cardiac arrest and expected outcomes. may also drive the strategy. SUMMARY This review aims to provide an overview of these different discussion points. The indication for early CAG should rely on multiple factors and an individual approach.
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