title: Out of hospital cardiac arrest survivors with inconclusive coronary angiogram: Impact of cardiovascular magnetic resonance on clinical management and decision-making.
abstract: Non-traumatic out of hospital cardiac arrest (OHCA) is the leading cause of death worldwide, mainly due to acute coronary syndromes. Urgent coronary angiography with view to revascularisation is recommended in patients with suspected acute coronary syndrome. Diagnosis and management of patients with inconclusive coronary angiogram (unobstructed coronaries or unidentified culprit lesion) is challenging. We sought to assess the role of Cardiovascular Magnetic Resonance (CMR) in the diagnosis and management of OHCA survivors with an inconclusive coronary angiogram.
  
  
  
  This is a retrospective multicentre CMR registry analysis of OHCA survivors with an inconclusive angiogram. Clinical, ECG and multi-modality imaging data were analysed. Clinical impact of CMR was defined as a change in diagnosis or management. Out of 174 OHCA survivors referred for CMR, 110 patients (63%, 84 male, median age 58) had an inconclusive angiogram. CMR identified a pathologic substrate in 76/110 patients (69%): ischemic heart disease was found in 45 (41%) and non-ischemic heart disease in 31 (28%). A structurally normal heart was found in 25 patients (23%) and non-specific findings in 9 (8%). As compared to trans-thoracic echocardiogram, CMR proved to be superior in identifying a pathologic substrate (69% vs 54%, p=0.018). The CMR study carried a clinical impact in 70% of patients, determining a change in diagnosis in 25%, in management in 29% and a change in both in 16%.
  
  
  
  CMR showed a promising role in the diagnostic work-up of OHCA survivors with inconclusive angiogram and its wider use should be considered.
authors.affiliation: Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Malborough Street, BS2 8HW, Bristol, United Kingdom; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Baritussio
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Zorzi
authors.affiliation: Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Malborough Street, BS2 8HW, Bristol, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Ghosh Dastidar
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Susana
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mattesi
authors.affiliation: Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Malborough Street, BS2 8HW, Bristol, United Kingdom.
authors.forename: J C L
authors.initials: JCL
authors.lastname: Rodrigues
authors.affiliation: Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Malborough Street, BS2 8HW, Bristol, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Biglino
authors.affiliation: Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Malborough Street, BS2 8HW, Bristol, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Scatteia
authors.affiliation: Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Malborough Street, BS2 8HW, Bristol, United Kingdom.
authors.forename: E
authors.initials: E
authors.lastname: De Garate
authors.affiliation: Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Malborough Street, BS2 8HW, Bristol, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Strange
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cacciavillani
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Malborough Street, BS2 8HW, Bristol, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Nisbet
authors.affiliation: Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Malborough Street, BS2 8HW, Bristol, United Kingdom.
authors.forename: G D
authors.initials: GD
authors.lastname: Angelini
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Corrado
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Perazzolo Marra
authors.affiliation: Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Malborough Street, BS2 8HW, Bristol, United Kingdom. Electronic address: c.bucciarelli-ducci@bristol.ac.uk.
authors.forename: C
authors.initials: C
authors.lastname: Bucciarelli-Ducci
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000208:Acute Disease; D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data
keywords: Cardiovascular magnetic resonance; Coronary angiogram; Out of hospital cardiac arrest