Abstract 101: Coronary Anatomy, Culprit Vessels, and Survival Following Out-of-Hospital Cardiac Arrest
Background: Aggressive post cardiac arrest (PCA) care improves long-term survival among those successfully resuscitated. The most promising post resuscitation treatments are therapeutic hypothermia (TH) and early coronary angiography /PCI. The 2013 ACCF/AHA STEMI Guidelines state that TH should be started as soon as possible in comatose patients with STEMI and out-of-hospital cardiac arrest and that immediate angiography and PCI (when indicated) be performed in resuscitated out-of-hospital cardiac arrest patients whose ECG shows STEMI. Our objective was to describe the acute coronary angiographic findings in patients with and without ST elevation post resuscitation.
Methods: We conducted a retrospective, observational study utilizing the INTCAR -Cardiology Registry. Statistical analysis utilized Chi Square testing.
Results: The database consisted of 754 patients (68% men; 57% with VFCA, 98% received TH), 417 (55%) of whom underwent coronary angiography post arrest. A culprit vessel was found in 222/417 (53%). The most common culprit vessel was the LAD (47%), followed by the RCA (33%), with the least common being the LCX (20%) [p<.001]. The majority of culprit vessels were occluded (84%). There were no differences in the occlusion rate among the 3 major coronaries (LAD 87%; RCA 81%; LCX 83%). Among those with ST elevation the distribution of culprit vessels was similar to the total population (LAD 53%; RCA 33%; LCX 14% [p<.001], but it was not so among those without ST elevation (LAD 35%; RCA 34%; LCX 31%) [NS]. In the subgroup with STEMI the culprit vessel was occluded in 92% of cases, while in those without ST elevation it was occluded in 68% [p<.001]. Stent thrombosis was rarely the culprit (3%), and was not different among vessels (LAD 2/99; RCA 2/69; LCX 2/41). There was no difference in survival to discharge among the different culprit vessel locations (LAD 40%; RCA 41%; LCX 39%).
Conclusion: A culprit coronary artery is common among PCA patients. Such culprits are usually acutely occluded, and most often either the LAD or RCA. In STEMI PCA patients the culprit vessel was occluded 92% of the time, while in patients without ST elevation the culprit was occluded in 68%. Survival to hospital discharge was similar among all culprit vessels.
- © 2013 by American Heart Association, Inc.