Abstract P70: Acute Angiographic Features in Patients with Resuscitated Cardiac Arrest
From January 1, 2003 to December 31, 2007, urgent coronary angiography was performed in 192 consecutive patients with electrocardiographic signs of STEMI after reestablishment of spontaneous circulation (ROSC) and in 50 out of 200 patients without STEMI after ROSC in whom acute ischemic etiology of cardiac arrest was suspected. Both groups were comparable in general characteristics with presence of shockable rhythm in 90%. Urgent coronary angiography revealed presence of coronary disease in all but 1 patient with STEMI (99%) and in 39 patients (78%) with no STEMI. Acute thrombotic event was found in 94% in STEMI group and 36% of no STEMI group (p<0.001). Coronary thrombosis was more complex in STEMI group with greater TIMI thrombus score (3.1 vs. 0.9; p<0.001) and less preserved anterograde flow (23% vs. 50%; p<0.05). Urgent PCI was attempted in 91% of STEMI group and in 32% in no STEMI with comparable success yielding to post procedural TIMI 3 in 81% and 88%, respectively (p=0.73). Peak cTnI was significantly greater in STEMI group (26.2+32.3 vs. 5.4+10.8, p<0.001). In conclusion, not only patients with STEMI after ROSC, but also more than one third of patients without STEMI have angiographic evidence of acute coronary thrombosis. Urgent coronary angiography and PCI should therefore be extended to patients without STEMI after ROSC if nonischemic etiology is not obvious.