Angiographic Characteristics of Coronary Disease and Postresuscitation Electrocardiograms in Patients With Aborted Cardiac Arrest Outside a Hospital
ABSTRACT Postresuscitation electrocardiogram (ECG) in patients with aborted cardiac death may demonstrate ST-elevation myocardial infarction (STEMI), ST-T changes, intraventricular conduction delay, or other nonspecific findings. In the present study, we compared ECG to urgent coronary angiogram in 158 consecutive patients with STEMI and 54 patients not fulfilling criteria for STEMI admitted to our hospital from January 1, 2003 through December 31, 2008. At least 1 obstructive lesion was present in 97% of patients with STEMI and in 59% of patients without STEMI with ≥1 occlusion in 82% and 39%, respectively (p <0.001). Obstructive lesion was considered acute in 89% of patients with STEMI and in 24% of patients without STEMI (p <0.001). An acute lesion in STEMI had a higher thrombus score (2.6 vs 1.3, p = 0.05) and more often presented with Thrombolysis In Myocardial Infarction grade 0 to 1 flow (75% vs 36%, p <0.01). Percutaneous coronary intervention, which was attempted in 148 lesions in patients with STEMI and in 17 lesions in patients without STEMI, resulted in final Thrombolysis In Myocardial Infarction grade 3 flow in 87% and 71%, respectively (p = 0.34). In conclusion, STEMI on postresuscitation ECG is usually associated with the presence of an acute culprit lesion. However, in the absence of STEMI, an acute culprit lesion is still present in 1/4 of patients. An acute lesion in STEMI is more thrombotic and more often leads to complete occlusion. Urgent percutaneous coronary intervention is feasible and successful regardless of postresuscitation ECG.
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ABSTRACT: The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not in any way whatsoever override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and, where appropriate and/or necessary, in consultation with that patient and the patient's care provider. Nor do the ESC Guidelines exempt health professionals from giving full and careful consideration to the relevant official, updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Kardiologia polska 08/2014; 72(12):1253-379. DOI:10.5603/KP.2014.0224 · 0.52 Impact Factor
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ABSTRACT: Any patient resuscitated from out-of-hospital cardiac arrest thought to have a cardiac etiology should have emergency coronary angiography upon arrival at the hospital. No current algorithm correctly identifies who has an acutely occluded coronary artery as their cardiac arrest trigger and who does not. However, 75% of those with ST elevation and 33% of those without ST elevation on their postresuscitation electrocardiogram have an acutely occluded coronary artery. To choose not to perform acute coronary angiography and reperfusion in all postresuscitation patients will leave at least one in three patients with significant myocardial loss, thus, resulting in chronic left ventricular dysfunction and heart failure. Zusammenfassung Jeder Patient mit Zustand nach erfolgreicher kardiopulmonaler Reanimation außerhalb des Krankenhauses sollte bei vermuteter kardialer Genese des Kreislaufstillstandes einer notfallmäßigen Koronarangiographie zugeführt werden. Mit keinem der bestehenden Algorithmen lässt sich sicher identifizieren, bei welchem Patienten der Herzstillstand durch einen Koronararterienverschluss ausgelöst wurde bzw. bei welchem Patienten durch andere Ursachen. Eine akut verschlossene Koronararterie haben 75% der Patienten mit und 33% der Patienten ohne ST-Streckenhebung im EKG nach Reanimation. Ohne eine akut durchgeführte Angiographie mit Rekanalisation für alle Patienten nach Reanimation wird es bei mindestens einem von drei Patienten zu einem signifikanten Myokardverlust mit konsekutiver linksventrikulärer Dysfunktion und Herzinsuffizienz kommen.Notfall 08/2012; 15(6):500-504. DOI:10.1007/s10049-011-1569-y · 0.32 Impact Factor
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ABSTRACT: Aggressive post-resuscitation care, in particular combining mild therapeutic hypothermia (MTH) with early coronary angiography (CAG) and percutaneous coronary intervention (PCI), may improve prognosis after out-of-hospital cardiac arrest (OHCA). The study aims to assess the value of immediate CAG or PCI in comatose survivors after OHCA treated with MTH and their association with outcomes. Observational, prospective analysis of all comatose, resuscitated patients treated with MTH at a tertiary centre and undergoing CAG or PCI ≤6 hours after OHCA, or non-invasively managed. Primary outcomes were 30-day and 1-year survival. From March 2004-December 2012, 141 (51%) out of 278 comatose patients after cardiac OHCA were treated with MTH (median age: 64.5 (interquartile range 55-73) years, males: 67%, first shockable rhythm: 70%, witnessed OHCA: 94%, interval OHCA-resuscitation≤20 min: 81%). Ninety-seven patients (69%) underwent early CAG, and 45 (32%) of them PCI. Patients undergoing CAG or PCI had a more favourable risk profile than subjects non-invasively managed. PCI treated patients had more bleedings, but no stent thrombosis occurred. Thirty-day and one-year unadjusted total mortality rates were 50% and 72% for non-invasively managed patients, 26% and 38.7% for patients submitted only to CAG and 32% and 36.6% for patients treated with PCI (p=0.0435 for early death, and p<0.0001 for one-year mortality, respectively). However, a propensity-matched score analysis did not confirm the survival advantage of invasive management (p=0.093). At multivariable analysis, clinical and OHCA-related variables as well as CAG, but not PCI, were associated with outcomes. Comatose patients cooled after OHCA and submitted to emergency CAG or PCI are a favourable outcome population that receives optimal post-arrest care. © The European Society of Cardiology 2014.12/2014; DOI:10.1177/2048872614564080