J Korean Soc Emerg Med.  2011 Oct;22(5):400-407.

Angiographic Findings of Out-of-Hospital Cardiac Arrest Patients Who were Successfully Resuscitated and Underwent Percutaneous Coronary Intervention

• Seo YW
• Lee KW
• Jang TC

Abstract

PURPOSE
Coronary artery disease is the most common cause of out-of-hospital cardiac arrest (OHCA). Primary percutaneous coronary intervention (PCI) is currently the most effective reperfusion strategy in acute myocardial infarction. The decision to perform PCI in an unconscious resuscitated OHCA patient is challenging because of uncertainty of the clinical course, status of the coronary artery and prognosis. The study evaluated clinical characteristics, angiographic findings and results of OHCA patients who were successfully resuscitated and underwent PCI.
METHODS
A retrospective study was performed from January, 2008 to December, 2010. Thirty four OHCA patients who successfully resuscitated and followed by PCI were enrolled. They were divided into significant and nonsignificant coronary artery group. Significant coronary artery group (n=23) was subdivided into survival and mortality subgroup.
RESULTS
Twenty three of the 34 patients had significant coronary disease on coronary angiography. There was no significant difference between the two groups in clinical and electrocardiography (ECG) findings based on age, sex, presence of chest pain, initial ECG, and ECG after return of spontaneous circulation (ROSC). The significant coronary artery group displayed higher creatine kinase-MB and troponin-I levels, and more common presence of ventricular fibrillation (VF) prior to PCI. The survival subgroup showed a lower number of significant stenotic coronary arteries, better neurologic finding prior to PCI and lower levels of cardiac biomarkers such as creatine kinase-MB and troponin-I.
CONCLUSION
PCI after ROSC in OHCA patients with presumed ischemic cardiac etiology may be reasonable, even in the absence of a definite clinical and ECG finding. The presence of VF or serial cardiac biomarkers is helpful in deciding whether to perform PCI.

Keyword

Out-of-Hospital cardiac arrest; Cardiac arrest; Percutaneous coronary intervention; Cardiopulmonary resuscitation

MeSH Terms

Biomarkers
Cardiopulmonary Resuscitation
Chest Pain
Coronary Angiography
Coronary Artery Disease
Coronary Disease
Coronary Vessels
Creatine
Electrocardiography
Heart Arrest
Humans
Myocardial Infarction
Neurologic Manifestations
Out-of-Hospital Cardiac Arrest
Percutaneous Coronary Intervention
Prognosis
Reperfusion
Retrospective Studies
Troponin I
Uncertainty
Unconscious (Psychology)
Ventricular Fibrillation
Creatine
Troponin I