Abstract 10615: Patient-Level Variables Predictive of Significant Coronary Lesions on Angiography After Cardiac Arrest
Background: Urgent coronary angiography is an important consideration in post-cardiac arrest resuscitation care. However, post-arrest angiography is often underutilized, as it carries some clinical risk and presents logistical barriers. Few data exist to guide clinical decisions on patient selection for post-arrest cardiac catheterization.
Objectives: To identify patient-level variables on initial post-arrest presentation that may correlate with significant coronary lesions on subsequent angiography.
Methods: Clinical, laboratory and angiographic data were collected on consecutive post-arrest patients from 7/2007 - 3/2010 who underwent coronary angiography during hospitalization. Univariate and multivariate statistical analyses were performed using logistic regression, with the dichotomized dependent variable of the presence or absence of at least one significant coronary lesion (>75% stenosis).
Results: A total of 88 subjects underwent post-arrest diagnostic coronary angiography. Mean age was 59.4 ± 13.4 years, 29/88 (33%) were female, and in 57/88 (65%) the initial arrest rhythm was VF/VT. Survival to discharge was achieved by 63/88 (72%) subjects. Coronary angiography demonstrated significant lesions in 54/88 (61%) of these patients. Univariate analysis demonstrated that significant lesions were most strongly associated with a prior known history of coronary artery disease (CAD) (OR 3.7, 95% CI 1.3-10.5, p=0.01) or smoking history (OR 2.74, 95% CI 1.1-6.7, p=0.02). No significant correlation was found with respect to subject age, arrest rhythm, elevated initial troponin, or ST/T wave abnormalities on initial ECG. Multivariate modeling with these variables confirmed that prior CAD was the most robust predictor of significant coronary lesions (OR 3.3, 95% CI 1.1-10.2, p=0.03).
Conclusions: Prior known CAD was the strongest predictor of post-arrest significant coronary lesions in this cohort. Importantly, arrest rhythm, initial troponin and ECG findings did not correlate with subsequent angiographic findings. These results will inform derivation of a decision rule for post-arrest angiography in future work.
- Cardiopulmonary resuscitation
- Post cardiac arrest care
- Post cardiac resuscitation
- Coronary artery disease
- © 2011 by American Heart Association, Inc.