title: Impact of urgent coronary angiography on mid-term clinical outcome of comatose out-of-hospital cardiac arrest survivors presenting without ST-segment elevation.
abstract: BACKGROUND
  Timing of coronary angiography (CAG) is still controversial in the out-of-hospital cardiac arrest survivors who present without ST-segment elevation.
  
  
  RESULTS
  We analysed a prospective registry of 158 comatose survivors of out-of-hospital cardiac arrest. For further analysis, we included 99 patients without ST-segment elevation on the initial electrocardiogram. All patients underwent temperature management. Urgent CAG (<2h from admission) was performed in 25% of the patients. A definite cause of the cardiac arrest could be identified during the index hospitalization in 82 patients: 36 had a non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and 46 had a non-ACS diagnosis. Eighty-seven patients (88%) survived the index hospitalization and 65 (66%) were alive at six months. A favourable neurological status (cerebral performance category ≤ 2) was observed in 56% of the patients at discharge and in 56% after six months of follow-up. Neither the survival nor the neurological outcome differed between the patients in whom the CAG was performed urgently upon the admission and the patients in whom the CAG was initially not performed, regardless of the aetiology of the cardiac arrest. On the other hand, performing an urgent CAG was safe and it did not prolong the average time to achieve an effective hypothermia.
  
  
  CONCLUSIONS
  Performing an urgent CAG in comatose cardiac arrest survivors without ST-segment elevation was not associated with better clinical and neurological outcome as compared to the initially conservative approach.
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic. Electronic address: klem@ikem.cz.
authors.forename: Martin
authors.initials: M
authors.lastname: Kleissner
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Sramko
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Kohoutek
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Kettner
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003128:Coma / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods*; D018153:Czech Republic / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Acute coronary syndrome; Cardiac arrest; Coronary angiography; Temperature management