title: Role of coronary angiography for out-of-hospital cardiac arrest survivors according to postreturn of spontaneous circulation on an electrocardiogram.
abstract: Survivors of out-of-hospital cardiac arrest (OHCA) have high mortality and morbidity. An acute coronary event is the most common cause of sudden cardiac death. For this reason, coronary angiography is an important diagnostic and treatment strategy for patients with postcardiac arrest. This study aimed to identify the correlation between postreturn of spontaneous circulation (ROSC) on an electrocardiogram (ECG) and results of coronary angiography of OHCA survivors.We collected data from our OHCA registry from January 2010 to November 2014. We categorized OHCA survivors into 2 groups according to post-ROSC ECG results. Emergent coronary artery angiography (CAG) (CAG performed within 12 hours after cardiac arrest) was performed in patients who showed ST segment elevation or new onset of left bundle branch block (LBBB) in post-ROSC ECG. For other patients, the decision for performing CAG was made according to agreement between the emergency physician and the cardiologist.During the study period, 472 OHCA victims visited our emergency department and underwent cardiopulmonary resuscitation. Among 198 OHCA survivors, 82 patients underwent coronary artery intervention. Thirty-one (70.4%) patients in the ST segment elevation or LBBB group and 10 (24.4%) patients in the nonspecific ECG group had coronary artery lesions (P < .01). Seven (18.4%) patients in the nonspecific ECG group showed coronary spasm.OHCA survivors without ST segment elevation or new onset LBBB still have significant coronary lesions in CAG. If there is no other obvious arrest cause in patients without significant changes in post ROSC ECG, CAG should be considered to rule out the possibility of coronary artery problems, including coronary spasm.
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Emergency Medicine, Doctorial Course, Graduate School, Kangwon National University, Chuncheon, Republic of Korea.
authors.forename: Tae Rim
authors.initials: TR
authors.lastname: Lee
authors.forename: Sung Yeon
authors.initials: SY
authors.lastname: Hwang
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Cha
authors.forename: Tae Gun
authors.initials: TG
authors.lastname: Shin
authors.forename: Min Seob
authors.initials: MS
authors.lastname: Sim
authors.forename: Ik Joon
authors.initials: IJ
authors.lastname: Jo
authors.forename: Keun Jeong
authors.initials: KJ
authors.lastname: Song
authors.forename: Joong Eui
authors.initials: JE
authors.lastname: Rhee
authors.forename: Yeon Kwon
authors.initials: YK
authors.lastname: Jeong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D017023:Coronary Angiography; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies