title: Predicting the Presence of an Acute Coronary Lesion Among Patients Resuscitated From Cardiac Arrest.
abstract: BACKGROUND
  A mechanism to stratify patients resuscitated from a cardiac arrest according to the likelihood of an acute coronary lesion would have significant utility. We thus sought to develop and validate a risk prediction model for the presence of an acute coronary lesion among patients resuscitated from an arrest.
  
  
  RESULTS
  All subjects undergoing coronary angiography after resuscitation from a cardiac arrest were identified in an ongoing institutional registry from 2009 to 2014. Backwards stepwise selection of candidate covariates was used to create a logistic regression model for the presence of an angiographic culprit lesion and internally validated with bootstrapping. A clinical point score was generated and its prognostic abilities compared with contemporary measures. Among 247 subjects undergoing coronary angiography after resuscitation from a cardiac arrest, 130 (52%) had an acute lesion in a coronary artery. A multivariable model-including angina, congestive heart failure symptoms, shockable arrest rhythm (ventricular fibrillation/ventricular tachycardia), and ST-elevations-had excellent discrimination (optimism corrected C-Statistic, 0.88) and calibration (Hosmer-Lemeshow P=0.540) for an acute coronary lesion. Compared with electrocardiographic findings alone, a point score based on this model more accurately predicted the presence of an acute lesion among patients resuscitated from a cardiac arrest (integrated discrimination improvement, 0.10; 95% confidence interval, 0.04-0.19; P<0.001).
  
  
  CONCLUSIONS
  Patients with a cardiac arrest can be risk stratified for the presence of an acute coronary lesion using 4 easily measured variables. This simple risk score may be used to improve patient selection for emergent coronary angiography among resuscitated patients.
authors.affiliation: From the Division of Cardiology, Department of Medicine (S.W.W., C.O., E.P., R.W.Y.), and Department of Medicine (L.C., J.B.S.), Massachusetts General Hospital, Boston.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Waldo
authors.affiliation: From the Division of Cardiology, Department of Medicine (S.W.W., C.O., E.P., R.W.Y.), and Department of Medicine (L.C., J.B.S.), Massachusetts General Hospital, Boston.
authors.forename: Lee
authors.initials: L
authors.lastname: Chang
authors.affiliation: From the Division of Cardiology, Department of Medicine (S.W.W., C.O., E.P., R.W.Y.), and Department of Medicine (L.C., J.B.S.), Massachusetts General Hospital, Boston.
authors.forename: Jordan B
authors.initials: JB
authors.lastname: Strom
authors.affiliation: From the Division of Cardiology, Department of Medicine (S.W.W., C.O., E.P., R.W.Y.), and Department of Medicine (L.C., J.B.S.), Massachusetts General Hospital, Boston.
authors.forename: Cashel
authors.initials: C
authors.lastname: O'Brien
authors.affiliation: From the Division of Cardiology, Department of Medicine (S.W.W., C.O., E.P., R.W.Y.), and Department of Medicine (L.C., J.B.S.), Massachusetts General Hospital, Boston.
authors.forename: Eugene
authors.initials: E
authors.lastname: Pomerantsev
authors.affiliation: From the Division of Cardiology, Department of Medicine (S.W.W., C.O., E.P., R.W.Y.), and Department of Medicine (L.C., J.B.S.), Massachusetts General Hospital, Boston. ryeh@partners.org.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012042:Registries; D012151:Resuscitation; D012306:Risk; D012307:Risk Factors; D016896:Treatment Outcome
keywords: cardiac arrest; culprit artery; culprit lesion; percutaneous coronary intervention