Emergency Coronary Angiography and Effects on Survival in Resuscitated Patients after Out-of-Hospital Cardiac Arrest

ABSTRACT

PURPOSE: The aim of this study is to evaluate the clinical characteristics and outcomes of patients with cardiac arrest without obvious extracardiac cause who underwent emergency angiography to determine the factors related to significant coronary artery disease in patients in whom coronary angiography was performed. We also addressed the issues around the survival benefit of coronary angiography and subsequent coronary intervention. METHODS: In total 91 patients during the period between 2004 and 2012 were included in the study. Clinical characteristics and coronary angiographic data were collected retrospectively. The success measurement of the study was set as survival at the time of hospital discharge. RESULTS: In comparison of the demographic and clinical variables of patients with and without emergency coronary angiography, only the electrocardiogram differed significantly between the two groups. Fifty four patients underwent an emergency coronary angiography, which was performed later for the remaining seven patients. Acute coronary lesions were observed in 38 patients (62%). Findings of electrocardiograms before and after return of spontaneous circulation (ROSC) were not statistically significant in relation to the prevalence of a culprit lesion. Neither an emergency coronary angiography nor successful coronary intervention showed correlation with survival at the time of hospital discharge. A shorter duration to return of spontaneous circulation, an initial shockable rhythm, and the absence of shock were found to be independent factors affecting discharge of patients alive in the overall study population (n=91). CONCLUSION: Considering the angiographic findings, neither the presence of a shockable rhythm nor ST-segment elevation myocardial infarction (STEMI) before and after ROSC were factors favouring acute coronary artery disease. The emergency coronary angiography did not show correlation with survival at hospital discharge in patients with a resuscitated cardiac arrest without non-cardiac cause. Factors positively related to survival should be considered when deciding on coronary angiography in order to identify patients in whom routine angiography is futile (e.g., the delay for return of spontaneous circulation and presence of shock).