Clinical factors associated with significant coronary lesions following out‐of‐hospital cardiac arrest

Abstract

Objectives Out‐of‐hospital cardiac arrest (OHCA) afflicts >350,000 people annually in the United States. While postarrest coronary angiography (CAG) with percutaneous coronary intervention (PCI) has been associated with improved survival in observational cohorts, substantial uncertainty exists regarding patient selection for postarrest CAG. We tested the hypothesis that symptoms consistent with acute coronary syndrome (ACS), including chest discomfort, prior to OHCAs are associated with significant coronary lesions identified on postarrest CAG. Methods We conducted a multicenter retrospective cohort study among eight regional hospitals. Adult patients who experienced atraumatic OHCA with successful initial resuscitation and subsequent CAG between January 2015 and December 2019 were included. We collected data on prehospital documentation of potential ACS symptoms prior to OHCA as well as clinical factors readily available during postarrest care. The primary outcome in multivariable regression modeling was the presence of significant coronary lesions (defined as >50% stenosis of left main or >75% stenosis of other coronary arteries). Results Four‐hundred patients were included. Median (interquartile range) age was 59 (51–69) years; 31% were female. At least one significant stenosis was found in 62%, of whom 71% received PCI. Clinical factors independently associated with a significant lesion included a history of myocardial infarction (adjusted odds ratio [aOR] = 6.5, [95% confidence interval {CI} = 1.3 to 32.4], p = 0.02), prearrest chest discomfort (aOR = 4.8 [95% CI = 2.1 to 11.8], p ≤ 0.001), ST‐segment elevations (aOR = 3.2 [95% CI = 1.7 to 6.3], p < 0.001), and an initial shockable rhythm (aOR = 1.9 [95% CI = 1.0 to 3.4], p = 0.05). Conclusions Among survivors of OHCA receiving CAG, history of prearrest chest discomfort was significantly and independently associated with significant coronary artery lesions on postarrest CAG. This suggests that we may be able to use prearrest symptoms to better risk stratify patients following OHCA to decide who will benefit from invasive angiography.

Individual socioeconomic status and risk of out‐of‐hospital cardiac arrest: A nationwide case–control analysis

“…Out-of-hospital cardiac arrest (OHCA) is a major public health concern. [1][2][3] Despite various efforts to improve the outcomes of cardiac arrest, the prognosis is generally poor. 1,4 Therefore, to prevent the occurrence of OHCA, efforts have been made to identify the population with the highest risk of OHCA.…”

“…Out‐of‐hospital cardiac arrest (OHCA) is a major public health concern 1–3 . Despite various efforts to improve the outcomes of cardiac arrest, the prognosis is generally poor 1,4 .…”

Cardiac Catheterization Laboratory Management of the Comatose Adult Patient With an Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association

“…Prearrest chest discomfort and a history of myocardial infarction is associated with 5-fold higher odds of acute coronary lesions. 13 A history of limited mobility or immobile state (eg, recent orthopedic surgery, prolonged hospitalization, extensive car or airplane rides) accompanied by prearrest dyspnea and an initial rhythm of pulseless electrical activity may be indicative of an acute pulmonary embolism. In many cases of OHCA, a detailed medical history and description of presenting symptoms are lacking, and therapeutic decisions must be made on the basis of other information.…”