Abstract 16386: Predicting Cardiac Arrest Myocardial Infarction (PreCAMI) in Out of Hospital Cardiac Arrest (OHCA) Survivors Lacking ST Elevations (STE)
Introduction: Coronary angiography (CA) and percutaneous intervention (PCI) after OHCA is recommended for suspected coronary occlusion based on ST elevation (STE) by ECG, yet 20-40% of OHCA patients without STE also have occlusions.
Hypothesis: Clinical criteria available prior to CA can be used to create a score to predict whether PCI will be attempted in non-STE OHCA patients with sensitivity (Sn) and specificity (Sp) nearing STE. Attempted PCI in non-STE OHCA will be associated with improved survival and functional outcomes.
Methods: We abstracted historical, demographic, resuscitation, ECG and lab data available within 6h of hospitalization in 156 non-STE OHCA who underwent early CA (<24h after OHCA). Logistic regression models tested associations between clinical variables and attempted PCI (model entry criteria p<0.1; stay criteria p<0.15). In these subjects and 304 non-STE OHCA who had delayed/absent CA, propensity adjusted regression examined associations of early CA (regardless of PCI attempt) or PCI attempt with survival or functional recovery (cerebral performance category 1-2, modified Rankin score 0-3 or discharge home or rehabilitation). Independent validation of score Sn and Sp was performed in a cohort where CA in non-STE OHCA is frequent (Cochin registry).
Results: 61/156 (39.1%) OHCA subjects without STE had attempted PCI. We derived a 4 variable (initial troponin, male sex, VF/VT presentation, epinephrine doses during CPR) parsimonious model (AUROC 0.78) which predicted PCI attempt with Sn 83%/Sp 51% comparing favorably to STE at our center (Sn 62%/Sp 77%). In Cochin 111/467 (24%) of CA resulted in PCI. Score validation in 407 OHCA with complete data yielded Sn 68%/Sp 50% for predicting PCI use in CA. Attempted PCI, but not CA alone, was associated with improved outcomes (US cohort). (Table).
Conclusion: We've validated a 4 variable score which predicts PCI use in OHCA without STE. PCI use in this population is associated with improved outcomes.
- Out of Hospital Cardiac Arrest
- Myocardial Infarction
- Coronary Angiography
- Percutaneous Coronary Intervention (PCI)
- Acute Coronary Syndrome
Author Disclosures: J. Fitzgibbon: None. F. Pike: None. F. Dumas: None. M. Scutella: None. L. Kowalski: None. D. Winger: None. L. Wang: None. J. Rittenberger: None. J.P. Mira: None. J. Elmer: None. C. Toma: None. C. Callaway: None. A. Cariou: None. C. Dezfulian: Consultant/Advisory Board; Modest; Ikaria/Mallinkrodt.
- © 2015 by American Heart Association, Inc.