title: Outcomes of Comatose Cardiac Arrest Survivors With and Without ST-Segment Elevation Myocardial Infarction: Importance of Coronary Angiography.
abstract: OBJECTIVE
  The aim of this study was to compare outcomes and coronary angiographic findings in post-cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  The 2013 STEMI guidelines recommend performing immediate angiography in resuscitated patients whose initial electrocardiogram shows STEMI. The optimal approach for those without STEMI post-cardiac arrest is less clear.
  
  
  METHODS
  A retrospective evaluation of a post-cardiac arrest registry was performed.
  
  
  RESULTS
  The database consisted of 746 comatose post-cardiac arrest patients including 198 with STEMI (26.5%) and 548 without STEMI (73.5%). Overall survival was greater in those with STEMI compared with those without (55.1% vs. 41.3%; p = 0.001), whereas in all patients who underwent immediate coronary angiography, survival was similar between those with and without STEMI (54.7% vs. 57.9%; p = 0.60). A culprit vessel was more frequently identified in those with STEMI, but also in one-third of patients without STEMI (80.2% vs. 33.2%; p = 0.001). The majority of culprit vessels were occluded (STEMI, 92.7%; no STEMI, 69.2%; p < 0.0001). An occluded culprit vessel was found in 74.3% of STEMI patients and in 22.9% of no STEMI patients. Among cardiac arrest survivors discharged from the hospital who had presented without STEMI, coronary angiography was associated with better functional outcome (93.3% vs. 78.7%; p < 0.003).
  
  
  CONCLUSIONS
  Early coronary angiography is associated with improved functional outcome among resuscitated patients with and without STEMI. Resuscitated patients with a presumed cardiac etiology appear to benefit from immediate coronary angiography.
authors.affiliation: Sarver Heart Center, University of Arizona, Tucson, Arizona. Electronic address: kernk@email.arizona.edu.
authors.forename: Karl B
authors.initials: KB
authors.lastname: Kern
authors.affiliation: Sarver Heart Center, University of Arizona, Tucson, Arizona.
authors.forename: Kapildeo
authors.initials: K
authors.lastname: Lotun
authors.affiliation: Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Nainesh
authors.initials: N
authors.lastname: Patel
authors.affiliation: Minneapolis Heart Institute, Minneapolis, Minnesota.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Mooney
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Hollenbeck
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: John A
authors.initials: JA
authors.lastname: McPherson
authors.affiliation: Saint Thomas Heart, Nashville, Tennessee.
authors.forename: Paul W
authors.initials: PW
authors.lastname: McMullan
authors.affiliation: Minneapolis Heart Institute, Minneapolis, Minnesota.
authors.forename: Barbara
authors.initials: B
authors.lastname: Unger
authors.affiliation: Sarver Heart Center, University of Arizona, Tucson, Arizona.
authors.forename: Chiu-Hsieh
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Maine Medical Center, Portland, Maine.
authors.forename: David B
authors.initials: DB
authors.lastname: Seder
mesh_terms: D000368:Aged; D003128:Coma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017023:Coronary Angiography; D004562:Electrocardiography; D005060:Europe; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
keywords: STEMI; cardiac arrest; coronary angiography; hypothermia; post-resuscitation syndrome