title: Post-resuscitation electrocardiograms, acute coronary findings and in-hospital prognosis of survivors of out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Identification of acute coronary lesions amenable to urgent intervention in survivors of out-of-hospital cardiac arrest is crucial. We aimed to compare the clinical and electrocardiographic characteristics to urgent coronary findings, and to analyze in-hospital prognosis of these patients.
  
  
  METHODS
  From January 2005 to December 2012 we retrospectively identified consecutive patients resuscitated from out-of-hospital cardiac arrest, and analyzed the clinical characteristics, post-resuscitation electrocardiogram and coronary angiogram of those who underwent emergent angiography. Mortality and neurologic status at discharge were also assessed.
  
  
  RESULTS
  Patients with ST-elevation more frequently had obstructive coronary artery disease (89% vs. 51%, p<0.001) or acute coronary occlusions (83% vs. 8%, p<0.001) than patients without ST-elevation. Independent predictors of an acute coronary occlusion were chest pain before arrest (OR 0.16, 95% CI 0.04-0.7, p=0.01), a shockable initial rhythm (OR 0.16, 95% CI 0.03-0.9, p=0.03), and ST-elevation on the post-resuscitation electrocardiogram (OR 0.02, 95% CI 0.004-0.13, p<0.001). Survival with favorable neurologic recovery at discharge was 59%. Independent predictors of mortality or unfavorable neurological outcome at discharge were absence of basic life support (OR 0.2, 95% CI 0.06-0.9, p=0.04), prolonged resuscitation time (OR 0.9, 95% CI 0.8-0.9, p=0.01), and necessity of vasopressors (OR 14.8, 95% CI 3.3-65.4, p=0.001).
  
  
  CONCLUSIONS
  Most patients with ST-elevation on the post-resuscitation electrocardiogram had an acute coronary occlusion, as opposed to patients without ST-elevation. Absence of basic life support, prolonged resuscitation time and use of vasopressors were independent predictors of worse in-hospital outcome.
authors.affiliation: Department of Cardiology, Doce de Octubre University Hospital, Madrid, Spain. Electronic address: juliogtejada@yahoo.com.
authors.forename: Julio
authors.initials: J
authors.lastname: Garcia-Tejada
authors.affiliation: Department of Cardiology, Doce de Octubre University Hospital, Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Jurado-Román
authors.affiliation: Department of Critical Care Medicine, Doce de Octubre University Hospital, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez
authors.affiliation: Department of Cardiology, Doce de Octubre University Hospital, Madrid, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Velázquez
authors.affiliation: Department of Cardiology, Doce de Octubre University Hospital, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Hernández
authors.affiliation: Department of Cardiology, Doce de Octubre University Hospital, Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Albarrán
authors.affiliation: Department of Critical Care Medicine, Doce de Octubre University Hospital, Madrid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Martín-Asenjo
authors.affiliation: Department of Cardiology, Doce de Octubre University Hospital, Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Granda-Nistal
authors.affiliation: Department of Critical Care Medicine, Doce de Octubre University Hospital, Madrid, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Coma
authors.affiliation: Department of Cardiology, Doce de Octubre University Hospital, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Tascón
mesh_terms: D016887:Cardiopulmonary Resuscitation; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D010351:Patient Discharge; D011379:Prognosis; D012189:Retrospective Studies; D017741:Survivors
keywords: Cardiac arrest; Electrocardiogram; Emergency coronary angiography; Prognosis