Relation of Chronic Total Occlusion to In-Hospital Mortality in the Patients With Sudden Cardiac Arrest Due to Acute Coronary Syndrome

Shinouchi, Kazuya; Ueda, Yasunori; Kato, Taishi; Nishida, Hiroki; Ozaki, Tatsuhisa; Kosugi, Shumpei; Iida, Yoshinori; Toriyama, Chieko; Ohashi, Takuya; Nakamura, Masayuki; Fukushima, Takashi; Horiuchi, Katsuhiro; Mishima, Tsuyoshi; Abe, Haruhiko; Awata, Masaki; Date, Motoo; Uematsu, Masaaki; Koretsune, Yukihiro

doi:10.1016/j.amjcard.2019.02.059

Cited by 6 publications

(2 citation statements)

References 17 publications

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“…28À30 As for CTOs, data in OHCA-patients is scarce. 31 Our findings indicate no association between CTO and shock-resistant VF. It should be noted that patients with CTO form a heterogeneous group, where in some the CTO is related to prior infarction, whereas in others there may be no signs of myocardial scar.…”

Section: Coronary Angiography Findingscontrasting

confidence: 47%

Coronary angiography findings in patients with shock-resistant ventricular fibrillation cardiac arrest

et al. 2021

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Introduction: Shock-resistant ventricular fibrillation (VF) poses a therapeutic challenge during out-of-hospital cardiac arrest (OHCA). For these patients, new treatment strategies are under active investigation, yet underlying trigger(s) and substrate(s) have been poorly characterised, and evidence on coronary angiography (CAG) data is often limited to studies without a control group.Methods: In our OHCA-registry, we studied CAG-findings in OHCA-patients with VF who underwent CAG after hospital arrival. We compared baseline demographics, arrest characteristics, CAG-findings and outcomes between patients with VF that was shock-resistant (defined as >3 shocks) or not shock-resistant ( 3 shocks).Results: Baseline demographics, arrest location, bystander resuscitation and AED-use did not differ between 105 patients with and 196 patients without shock-resistant VF. Shock-resistant VF-patients required more shocks, with higher proportions endotracheal intubation, mechanical CPR, amiodaron and epinephrine. In both groups, significant coronary artery disease (!1 stenosis >70%) was highly prevalent (78% vs. 77%, p = 0.76). Acute coronary occlusions (ACOs) were more prevalent in shock-resistant VF-patients (41% vs. 26%, p = 0.006). Chronic total occlusions did not differ between groups (29% vs. 33%, p = 0.47). There was an association between increasing numbers of shocks and a higher likelihood of ACO. Shockresistant VF-patients had lower proportions 24-h survival (75% vs. 93%, p < 0.001) and survival to discharge (61% vs. 78%, p = 0.002). Conclusion:In this cohort of OHCA-patients with VF and CAG after transport, acute coronary occlusions were more prevalent in patients with shockresistant VF compared to VF that was not shock-resistant, and their clinical outcome was worse. Confirmative studies are warranted for this potentially reversible therapeutic target.

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Section: Coronary Angiography Findingscontrasting

confidence: 47%

Coronary angiography findings in patients with shock-resistant ventricular fibrillation cardiac arrest

et al. 2021

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“…Nevertheless, at long-term follow-up, patients with non-revascularized CTOs have a worse outcome compared with those revascularized, with a three-fold risk of sudden cardiac death and ventricular arrythmias [ 34 ]. Moreover, in patients with cardiac arrest and acute coronary syndrome, the presence of a CTO is significantly associated with higher in-hospital mortality [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Coronary Revascularization after Out-of-Hospital Cardiac Arrest: A Review of the Literature and a Case Series

Scavelli

Cartella

Montalto

et al. 2022

JCM

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Out-of-hospital cardiac arrest (OHCA) is still associated with high mortality and severe complications, despite major treatment advances in this field. Ischemic heart disease is a common cause of OHCA, and current guidelines clearly recommend performing immediate coronary angiography (CAG) in patients whose post-resuscitation electrocardiogram shows ST-segment elevation (STE). Contrarily, the optimal approach and the advantage of early revascularization in cases of no STE is less clear, and decisions are often based on the individual experience of the center. Numerous studies have been conducted on this topic and have provided contradictory evidence; however, more recently, results from several randomized clinical trials have suggested that performing early CAG has no impact on overall survival in patients without STE.

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Chronic total occlusion percutaneous coronary intervention in patients presenting with acute coronary syndromes

Brilakis¹

2023

Manual of Chronic Total Occlusion Percutaneous Coronary Interventions

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Relation of Chronic Total Occlusion to In-Hospital Mortality in the Patients With Sudden Cardiac Arrest Due to Acute Coronary Syndrome

Cited by 6 publications

References 17 publications

Coronary angiography findings in patients with shock-resistant ventricular fibrillation cardiac arrest

Coronary angiography findings in patients with shock-resistant ventricular fibrillation cardiac arrest

Percutaneous Coronary Revascularization after Out-of-Hospital Cardiac Arrest: A Review of the Literature and a Case Series

Chronic total occlusion percutaneous coronary intervention in patients presenting with acute coronary syndromes

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