Abstract 122: A Model for Predicting Angiographically Normal Coronary Arteries in Survivors of Out of Hospital Cardiac Arrest
Background: It is recommended that all survivors of OHCA have immediate CAG although half of the survivors have normal coronary arteries. Our aim was to develop a model to identify those who have angiographically normal coronary arteries to reduce unnecessary CAG.
Methods: A retrospective, observational, cohort study was conducted on consecutive adult survivors who received immediate CAG between June 1, 2006 and March 31, 2011 in a teaching hospital, Japan. A recursive partitioning model was fit by analyzing the relationship between the survivors with normal coronary arteries and clinical and ECG findings.
Results: All patients had survived one month after admission. The neurologic status of 45/47 (96%) patients was CPC 1, that of one patient was CPC 2, and that of one patient was CPC3. According to CAG, 25/47 (53%) patients had normal coronary arteries and 22 (47%) had abnormal. Younger age was related to normal coronary arteries (p<0.001). All patients 50 years old or younger had normal coronary arteries. No one with normal coronary arteries had a past history of diabetes mellitus, ACS, or percutaneous coronary intervention (p=0.0069, p=0.0069, p=0.017, respectively). VT/VF on EMT arrival was not related to abnormal coronary arteries (p=1.0000). Chest pain before arrest was not related to status of coronary arteries (p=1.0000). Any abnormal ST segment change or elevation on their ECG was related to abnormal coronary arteries (p=0.0045, p=0.0200). Expert opinions relatively accurately predicted the presence of normal coronary arteries. Inter-rater reliability of experts opinions was intermediate (κ=0.5616). The partitioning model for predicting angiographically normal coronary arteries showed that all patients (8/8) with no ST segment change on their ECG at the ED had normal coronary arteries. 8/10 (80%) patients had normal coronary arteries when they had no history of ACS and when they had a history of arrhythmia even if some ST segment changes were apparent on their ECG. The AUC of this model (0.8004) was greater than that of expert opinions only (0.7054).
Conclusions: Survivors of OHCA do not need CAG in two cases: if there are no ST segment changes on their ECG; if there are some ST segment changes on their ECG and no history of ACS, but they have a history of arrhythmia.
- © 2013 by American Heart Association, Inc.