title: Association between angiographic culprit lesion and out-of-hospital cardiac arrest in ST-elevation myocardial infarction patients.
abstract: BACKGROUND
  Factors related to the occurrence of out-of-hospital cardiac arrest (OHCA) in ST-elevation myocardial infarction (STEMI) are still poorly understood. The current study sought to compare STEMI patients presenting with and without OHCA to identify angiographic factors related to OHCA.
  
  
  METHODS
  This multicenter registry consisted of consecutive STEMI patients, including OHCA patients with return-of-spontaneous circulation. Patients were treated with primary percutaneous coronary intervention (PCI) and therapeutic hypothermia when indicated. Outcome consisted of in-hospital neurological recovery, scored using the Cerebral Performance Categories (CPC) scale, and 1-year survival. Logistic regression was used to identify factors associated with OHCA and survival was displayed with Kaplan-Meier curves and compared using log rank tests.
  
  
  RESULTS
  In total, 224 patients presented with OHCA and 3259 without OHCA. Average age was 63.3 years and 75% of patients were male. OHCA occurred prior to ambulance arrival in 68% of patients and 48% required intubation. Culprit lesion was associated with OHCA: risk was highest for proximal left coronary lesions and lowest for right coronary lesions. Also, culprit lesion determined the risk of cardiogenic shock and sub-optimal reperfusion after PCI, which were strongly related to survival after OHCA. Neurological recovery was acceptable (CPC≤2) in 77.1% of OHCA patients and did not differ between culprit lesions.
  
  
  CONCLUSIONS
  In the present STEMI population, coronary culprit lesion was associated with the occurrence of OHCA. Moreover, culprit lesion influenced the risk of cardiogenic shock and success of reperfusion, both of which were related to prognosis of OHCA patients.
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands; Medical Center Leeuwarden, Leeuwarden, The Netherlands. Electronic address: m.a.velders@lumc.nl.
authors.forename: M A
authors.initials: MA
authors.lastname: Velders
authors.forename: N
authors.initials: N
authors.lastname: van Boven
authors.forename: H
authors.initials: H
authors.lastname: Boden
authors.forename: B L
authors.initials: BL
authors.lastname: van der Hoeven
authors.forename: A A C M
authors.initials: AA
authors.lastname: Heestermans
authors.forename: J W
authors.initials: JW
authors.lastname: Jukema
authors.forename: E
authors.initials: E
authors.lastname: de Jonge
authors.forename: M A
authors.initials: MA
authors.lastname: Kuiper
authors.forename: A J
authors.initials: AJ
authors.lastname: van Boven
authors.forename: S H
authors.initials: SH
authors.lastname: Hofma
authors.forename: M J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: V A W M
authors.initials: VA
authors.lastname: Umans
mesh_terms: D017023:Coronary Angiography; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D009426:Netherlands / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Out-of-hospital cardiac arrest; Primary percutaneous coronary intervention; ST-elevation myocardial infarction; Therapeutic hypothermia