1. Acute Coronary Occlusion in Patients With Non-ST-Segment Elevation Out-of-Hospital Cardiac Arrest
- Author
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Alessandro Spirito, Lukas Vaisnora, Athanasios Papadis, Fortunato Iacovelli, Celestino Sardu, Alexandra Selberg, Sarah Bär, Raminta Kavaliauskaite, Fabrice Temperli, Babken Asatryan, Thomas Pilgrim, Lukas Hunziker, Dik Heg, Marco Valgimigli, Stephan Windecker, Lorenz Räber, Spirito, A., Vaisnora, L., Papadis, A., Iacovelli, F., Sardu, C., Selberg, A., Bar, S., Kavaliauskaite, R., Temperli, F., Asatryan, B., Pilgrim, T., Hunziker, L., Heg, D., Valgimigli, M., Windecker, S., and Raber, L.
- Subjects
death ,non–ST-segment elevation ,coronary angiography ,out-of-hospital cardiac arrest ,Cardiology and Cardiovascular Medicine ,610 Medizin und Gesundheit ,coronary occlusion - Abstract
Background: According to current guidelines, hemodynamic status should guide the decision between immediate and delayed coronary angiography (CAG) in out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation. A delayed strategy is advised in hemodynamically stable patients, and an immediate approach is recommended in unstable patients. Objectives: This study sought to assess the frequency, predictors, and clinical impact of acute coronary occlusion in hemodynamically stable and unstable OHCA patients without ST-segment elevation. Methods: Consecutive unconscious OHCA patients without ST-segment elevation who were undergoing CAG at Bern University Hospital (Bern, Switzerland) between 2011 and 2019 were included. Frequency and predictors of acute coronary artery occlusions and their impact on all-cause and cardiovascular mortality at 1 year were assessed. Results: Among the 386 patients, 169 (43.8%) were hemodynamically stable. Acute coronary occlusions were found in 19.5% of stable and 24.0% of unstable OHCA patients (P=0.407), and the presence of these occlusions was predicted by initial chest pain and shockable rhythm, but not by hemodynamic status. Acute coronary occlusion was associated with an increased risk of cardiovascular death (adjusted HR: 2.74; 95%CI: 1.22-6.15) but not of all-cause death (adjusted HR:0.72; 95%CI: 0.44-1.18). Hemodynamic instability was not predictive of fatal outcomes. Conclusions: Acute coronary artery occlusions were found in 1 in 5 OHCA patients without ST-segment elevation.The frequency of these occlusions did not differ between stable and unstable patients, and the occlusions wereassociated with a higher risk of cardiovascular death. In OHCA patients without ST-segment elevation, chest painorshockable rhythm rather than hemodynamic status identifies patients with acute coronary occlusion.
- Published
- 2023