Abstract 15192: Out of Hospital Arrest: Are We Performing Coronary Angiography Often Enough?
Objective: To determine the etiologies, coronary angiography results and survival of patients admitted to the Intensive Care Unit (ICU) at the Gold Coast Hospital, after out of hospital cardiac arrest (OHCA). To correlate ECG morphology after return of spontaneous circulation (ROSC) to angiographic findings.
Methods: Retrospective case series using data from the ICU AORTIC database between Jan 1999 and Oct 2011. Further collection of data and ECGs from patients charts from Mar 2005 to Oct 2011 when interventional cardiology service was onsite. Any patient without clear non-cardiac cause was classified as cardiac.
Results: Overall 287 survivors were admitted to the Intensive care unit. Survival was 38% in the cardiac group and 28% in the non-cardiac group. 107 patients had VF with 56% survival. In the period when interventional cardiology service was onsite (Mar 05 - Oct 2011), 162 patients were admitted to ICU. 110 patients were classified cardiac. 55 patients had angiograms, of which 38 had obstructive coronary artery disease warranting intervention. 108 ECGs on ROSC were available: 29 had ST elevation, 23 had no change from prior ECGs, 9 had normal ECGs, and 47 had other changes. In the group that had no ST elevation (n=79), 33 angiograms were performed of which 17 showed acute occlusions (51%). Statistical analysis revealed that since interventional cardiology service has been onsite, ECG morphology is strongly associated with the likelihood of receiving angiography (p=0.002). Survival depended not on whether or not the angiogram was performed (p=0.44), but upon finding a lesion that is treatable with percutaneous coronary intervention, or surgical revascularization (p<0.01). Although ST elevation after ROSC strongly predicts a positive angiogram result, 30% of patients having obstructive coronary artery disease did not have ST elevation on ECG.
Conclusion: Survival in the cardiac group (38%) was better than the non-cardiac group (28%). In OHCA, ST elevation on ECG is not sensitive enough to select all patients with significant coronary artery disease. However, patients with new ischemic changes on ECG were more likely to get angiograms. Definitive management of coronary occlusions was predictive of survival.
- © 2012 by American Heart Association, Inc.