Abstract 13464: Underutilization of Invasive Coronary Angiography Post Out of Hospital Cardiac Arrest: is a Paradigm Shift Needed?
BACKGROUND: The immediate post-resuscitation 12-lead electrocardiogram (ECG) aids in the diagnosis of an acute coronary syndrome (ACS) following an out-of-hospital cardiac arrest (OHCA). Guidelines support immediate coronary angiography (CA) for a finding of acute ST-elevation (STE), no such recommendations exist for ST-depression (STD) post-OHCA. We aimed to assess the relationship of STE and STD on the post-resuscitation ECG with diagnostic CA findings.
METHODS: A retrospective analysis of consecutive patients admitted to a Vancouver Hospital with CA capability post-OHCA, between November 2009 and December 2011. Patients were identified using the Resuscitation Outcomes Consortium Cardiac Arrest Registry and included if they had an interpretable post-resuscitation ECG. ST-segment changes >0.1mV in 2 contiguous leads were deemed significant. A stenosis ≤70% (or ≤50% for left main) was defined as obstructive coronary artery disease (CAD).
RESULTS: Our cohort of n=231 pts had a mean age of 65±17y and 74% were males. The presenting rhythm was ventricular tachycardia/fibrillation (49%), pulseless electrical activity (19%), asystole (17%), and unspecified (15%). The post-resuscitation ECG demonstrated STE in 33%, STD in 27% and no ST abnormality in 40%. The QRS morphology included narrow complex (42%), intraventricular conduction delay (25%), RBBB (27%), and LBBB (6%). The rate of CA was 41% (n=94), with a mean LVEF of 42%. In Table 1 below the odd ratios describe the association of STE and STD with CA findings compared to patients with no ST abnormality.
CONCLUSIONS: A high proportion of patients with OHCA demonstrated ST-segment abnormalities on the post-resuscitation ECG. The association with obstructive CAD was greatest with STE, the presence of STD showed a trend towards an association with both, occlusive and obstructive CAD. A randomized clinical trial is needed to assess the utility of diagnostic CA in OHCA patients with STD on the post-resuscitation ECG.
Author Disclosures: K. Ramanathan: None. C. Cheung: None. B. Grunau: None. M. Habibi: None. M.W. Deyell: None. C.M. Taylor: None. D. Stub: None. C.B. Fordyce: None. K. Kaila: None. J. Christenson: None. G.C. Wong: None. M.E. Farkouh: None.
- © 2014 by American Heart Association, Inc.