Post resuscitation electrocardiogram for coronary angiography indication after out-of-hospital cardiac arrest. (1st July 2020)

• Record Type: Journal Article
• Authors: Leclercq, Florence; Lonjon, Clément; Marin, Grégory; Akodad, Mariama; Roubille, François; Macia, Jean-Christophe; Cornillet, Luc; Gervasoni, Richard; Schmutz, Laurent; Ledermann, Bertrand; Colson, Pascal; Cayla, Guillaume; Lattuca, Benoit
• Is Part Of: International journal of cardiology. Volume 310(2020)
• Page Start: 73
• Page End: 79
• Publication Date: 2020-07-01
• Subjects: Coronary angiography -- Cardiac arrest -- Resuscitation -- Repolarization disorders -- ECG -- Mortality; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.03.037
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Coronary angiography is the standard of care after Out-of-Hospital Cardiac Arrest (OHCA), but its benefit for patients without persistent ST-segment elevation (STE) remains controversial. Methods: All patients admitted for coronary angiography after a resuscitated OHCA were consecutively included in this prospective study. Three patient groups were defined according to post-resuscitation ECG: STE or new left bundle branch block (LBBB) (group 1); other ST/T repolarization disorders (group 2) and no repolarisation disorders (group 3). The proportion and predictive factors of an acute coronary lesion, defined by acute coronary occlusion or thrombotic lesion or lesion associated with flow impairment, were evaluated according to different groups as well as thirty-day mortality. Results: Among 129 consecutive patients: 62 (48.1%), 30 (23.3%) and 30 (23.3%) patients were included in groups 1, 2 and 3 respectively. An acute coronary lesion was observed in 43% ( n = 55) of patients, mainly in group 1 ( n = 44, 70.9%). Initial coronary TIMI 0/1 flow was more frequently observed in group 1 than in group 2 ( n = 25, 40.3% vs n = 1, 3.3%) and never in group 3. Chest pain and STE or new LBBB were independently associated with an acute coronary lesion (adj. OR = 7.14 [1.85–25.00]; p = 0.004 and adj. OR = 11.10 [3.70–33.33]; p < 0.001 respectively). In absence of any repolarization disorders, acute coronary lesion or occlusion were excluded with negative predictive values of 93.3% and 100% respectively. The one-month survival rate was 38.8% and was better in patients among the group 1 compared to those from the 2 other groups ( n = 28, 45.2% vs n = 21, 35%, respectively; p = 0.014). Conclusion: Considering the high negative predictive value of post-resuscitation ECG to exclude acute coronary lesion and occlusion after OHCA, a delayed coronary angiography appears a reliable alternative for patients without repolarization disorders. Highlights: Post-resuscitation ECG appears as a useful triage method to guide the indication of immediate coronary angiography Except for patients with ST-segment elevation or new LBBB, an acute coronary occlusion was very rarely observed (< 2%) Absence of any repolarization disorders was associated with a very high predictive value to exclude acute coronary lesion Chest pain and ST-segment elevation or new LBBB were the best predictive factors of an acute coronary lesion