Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG—Short- and long-term survival

Elfwén, Ludvig; Lagedal, Rickard; James, Stefan; Jonsson, Martin; Jensen, Ulf; Ringh, Mattias; Claesson, Andreas; Oldgren, Jonas; Herlitz, Johan; Rubertsson, Sten; Nordberg, Per

doi:10.1016/j.ahj.2018.03.009

Cited by 36 publications

(42 citation statements)

References 23 publications

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“…The ECG is the first diagnostic tool to differentiate between a coronary or non-coronary cause of the arrest. However, post-resuscitation ECGs regularly show widespread repolarisation and conduction abnormalities [13] due to the global myocardial ischaemia-reperfusion state, even in the absence of coronary artery disease. In this light, studies are focusing on the potential diagnostic value of the ECG recorded during cardiac arrest by analysing the morphological characteristics of the ventricular fibrillation (VF) waveform [14,15].…”

Section: The Clinical Conundrum In Post-arrest Carementioning

confidence: 99%

“…Numerous studies have evaluated optimal timing of coronary angiography after cardiac arrest, including different patient populations, ECG dynamics and pre-hospital settings with often contradictory outcomes (Tab. 1; [13,[25][26][27][28][29][30][31][32][33][34][35][36]).…”

Section: Observational Studies: Delayed Versus Immediate Coronary Angmentioning

confidence: 99%

Section: Observational Studies: Delayed Versus Immediate Coronary Angmentioning

confidence: 99%

“…Two recent studies suggest that coronary angiography should be considered in all patients, irrespective of post-resuscitation ECG findings [13,26]. Elfwén et al performed a prospective study of 799 patients who achieved ROSC after witnessed OHCA with initial shockable rhythm in the absence of STE, comparing early versus delayed angiography [13]. For patients who underwent coronary angiography, relatively high rates of acute coronary occlusions (early group 27% vs. delayed 20%) were reported with a subsequent high PCI rate (early group 51% vs. non-early 34%), which was associated with improved survival at 30-days (65%…”

Section: Observational Studies: Delayed Versus Immediate Coronary Angmentioning

confidence: 99%

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The role of coronary angiography in out-of-hospital cardiac arrest patients in the absence of ST-segment elevation: A literature review

et al. 2020

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Out-of-hospital cardiac arrest (OHCA) is a major cause of death. Although the aetiology of cardiac arrest can be diverse, the most common cause is ischaemic heart disease. Coronary angiography and percutaneous coronary intervention, if indicated, has been associated with improved long-term survival for patients with initial shockable rhythm. However, in patients without ST-segment elevation on the postresuscitation electrocardiogram, the optimal timing of performing this invasive procedure is uncertain. One important challenge that clinicians face is to appropriately select patients that will benefit from immediate coronary angiography, yet avoid unnecessary delay of intensive care support and targeted temperature management. Observational studies have reported contradictory results and until recently, randomised trials were lacking. The Coronary Angiography after Cardiac Arrest without ST-segment elevation (COACT) was the first randomised trial that provided comparative information between coronary angiography treatment strategies. This literature review will provide the current knowledge and gaps in the literature regarding optimal care for patients successfully resuscitated from OHCA in the absence of ST-segment elevation and will primarily focus on the role and timing of coronary angiography in this high-risk patient population.

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Section: The Clinical Conundrum In Post-arrest Carementioning

confidence: 99%

Section: Observational Studies: Delayed Versus Immediate Coronary Angmentioning

confidence: 99%

Section: Observational Studies: Delayed Versus Immediate Coronary Angmentioning

confidence: 99%

Section: Observational Studies: Delayed Versus Immediate Coronary Angmentioning

confidence: 99%

See 2 more Smart Citations

The role of coronary angiography in out-of-hospital cardiac arrest patients in the absence of ST-segment elevation: A literature review

et al. 2020

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“…Dumas és mtsai a PROCAT II regiszter adatai alapján azt találták, hogy a betegek 29%-ában volt olyan culprit laesio, mely a hirtelen szívhalálért felelős lehetett[20]. Elfwén és mtsai 2018-as közleményében sokkolható ritmussal resuscitatióban részesített betegek ST-eleváció nélküli csoportjában ugyancsak 27%-ban előforduló koszorúér-okklúzió szerepel[21]. Millin és mtsai 11 közleményt feldolgozó metaanalízise szerint a nem ST-elevációs betegek 32%ában fordul elő intervenciót igénylő culprit laesio[22].…”

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Újraélesztést követő koszorúér-angiográfia és katéteres intervenció

Rudas

Zima

2019

Orvosi Hetilap

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Out-of-hospital cardiac arrest (OHCA) presents a great challenge for the health care systems even in the highly developed countries. For several decades, our greatest efforts have been directed toward the improvement of the prehospital management, including promotion of lay resuscitation and deployment of public access automated defibrillators. Recently, the importance of the hospital phase of the OHCA-management has been also emphasized. Attention has been paid to targeted temperature management and also to early coronary intervention. For those patients who present with ST-elevation on their post-resuscitation ECG, our approach is straightforward: urgent coronary angiography is indicated. The optimal management of those survivors of OHCA who present without ST-elevation is, however, still debated. Although up to 30% of these subjects also suffer from acute occlusive epicardial coronary disease, the clear benefit of urgent coronary angiography for the whole group is yet to be documented. Several large-scale randomized studies are under way to resolve this question. In our present review we detail the above controversies and outline the future directions. Orv Hetil. 2019; 160(46): 1826–1831.

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Long-term Survival After Out-of-Hospital Cardiac Arrest

et al. 2022

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IMPORTANCE Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce.OBJECTIVE To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA.DATA SOURCES A systematic search of the EMBASE and MEDLINE databases was performed from database inception to March 25, 2021.STUDY SELECTION Clinical studies reporting long-term survival after OHCA were selected based on predefined inclusion and exclusion criteria according to a preregistered study protocol.DATA EXTRACTION AND SYNTHESIS Patient data were reconstructed from Kaplan-Meier curves using an iterative algorithm and then pooled to generate survival curves. As a separate analysis, an aggregate data meta-analysis was performed. MAIN OUTCOMES AND MEASURESThe primary outcome was long-term survival (>12 months) after OHCA for patients surviving to hospital discharge or 30 days after OHCA. RESULTSThe search identified 15 347 reports, of which 21 studies (11 800 patients) were included in the Kaplan-Meier-based meta-analysis and 33 studies (16 933 patients) in an aggregate data meta-analysis. In the Kaplan-Meier-based analysis, the median survival time for patients surviving to hospital discharge was 5.0 years (IQR, 2.3-7.9 years). The estimated survival rates were 82.8% (95% CI, 81.9%-83.7%) at 3 years, 77.0% (95% CI, 75.9%-78.0%) at 5 years, 63.9% (95% CI, 62.3%-65.4%) at 10 years, and 57.5% (95% CI, 54.8%-60.1%) at 15 years. Compared with patients with a nonshockable initial rhythm, patients with a shockable rhythm had a lower risk of long-term mortality (hazard ratio, 0.30; 95% CI, 0.23-0.39; P < .001). Different analyses, including an aggregate data meta-analysis, confirmed these results. CONCLUSIONS AND RELEVANCEIn this comprehensive systematic review and meta-analysis, long-term survival after 10 years in patients surviving the initial hospital stay after OHCA was between 62% and 64%. Additional research is needed to understand and improve the long-term survival in this vulnerable patient population.

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Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG—Short- and long-term survival

Cited by 36 publications

References 23 publications

The role of coronary angiography in out-of-hospital cardiac arrest patients in the absence of ST-segment elevation: A literature review

The role of coronary angiography in out-of-hospital cardiac arrest patients in the absence of ST-segment elevation: A literature review

Újraélesztést követő koszorúér-angiográfia és katéteres intervenció

Long-term Survival After Out-of-Hospital Cardiac Arrest

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