Abstract 19555: Out of Hospital Cardiac Arrest Survivors With Inconclusive Coronary Angiogram: Impact of Cardiovascular Magnetic Resonance on Clinical Management and Decision-Making
Background: Non-traumatic out of hospital cardiac arrest (OHCA) is the leading cause of death worldwide, and in up to two thirds of cases it is secondary to acute coronary syndromes. Urgent angiography with view to primary percutaneous coronary intervention (PPCI) is a class IB recommendation according to international guidelines. Diagnosis and management of patients with inconclusive coronary angiogram (unobstructed coronaries or unidentified culprit lesion) is challenging.
Objectives: We sought to assess the role of Cardiovascular Magnetic Resonance (CMR) in the diagnosis and management of OHCA survivors with an inconclusive coronary angiogram.
Methods: This is a retrospective multicentre CMR registry analysis of consecutive OHCA survivors undergoing urgent coronary angiogram and CMR. Clinical, electrocardiographic (ECG) and multi-modality imaging data from patients with an inconclusive angiogram were analysed. Clinical impact of CMR was defined either as a change in diagnosis, as compared to a multi-parametric pre-CMR diagnosis, or a change in management.
Results: Out of 174 OHCA survivors referred for CMR following urgent angiogram, we identified 110 patients (63%, 84 male, median age 58, IQR 46-68) with inconclusive angiogram. CMR identified a pathologic substrate in 76/110 patients (69%): ischemic heart disease was found in 45 patients (41%) and non-ischemic heart disease in 31 (28%), A structurally normal heart was found in 25 patients (23%) and non-specific findings were reported in 9 (8%). As compared to TTE, CMR proved to be superior in identifying a substrate of the event (69% vs 54%, p=0.018). This superior diagnostic ability carried additional value and clinical impact in 70% of patients, determining a change in diagnosis in 25% of patients, a change in management in 29% and a change both in diagnosis and management in 16%.
Conclusions: CMR has a promising role in the clinical and diagnostic work-up of OHCA survivors with inconclusive angiogram and its wider use in this cohort of patients should be considered.
Author Disclosures: A. Baritussio: None. A. Zorzi: None. A. Ghosh Dastidar: None. A. Susana: None. G. Mattesi: None. J. Rodrigues: None. G. Biglino: None. A. Scatteia: None. E. De Garate: None. J. Strange: None. L. Cacciavillani: None. D. Corrado: None. M. Perazzolo Marra: None. C. Bucciarelli-Ducci: Consultant/Advisory Board; Modest; Circle Cardiovascular Imaging.
- © 2016 by American Heart Association, Inc.