Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2017; 9(8): 702-709
Published online Aug 26, 2017. doi: 10.4330/wjc.v9.i8.702
Coronary angiography findings in cardiac arrest patients with non-diagnostic post-resuscitation electrocardiogram: A comparison of shockable and non-shockable initial rhythms
Pedro Martínez-Losas, Pablo Salinas, Carlos Ferrera, María Teresa Nogales-Romo, Francisco Noriega, María Del Trigo, Iván Javier Núñez-Gil, Luis Nombela-Franco, Nieves Gonzalo, Pilar Jiménez-Quevedo, Javier Escaned, Antonio Fernández-Ortiz, Carlos Macaya, Ana Viana-Tejedor
Pedro Martínez-Losas, Pablo Salinas, Carlos Ferrera, María Teresa Nogales-Romo, Francisco Noriega, María Del Trigo, Iván Javier Nuñez-Gil, Luis Nombela-Franco, Nieves Gonzalo, Pilar Jiménez-Quevedo, Javier Escaned, Antonio Fernández-Ortiz, Carlos Macaya, Ana Viana-Tejedor, Interventional Cardiology and Coronary Care Unit, Cardiovascular Institute, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain
Author contributions: Martínez-Losas P, Salinas P, Ferrera C and Nogales-Romo MT contributed equally to this work; Salinas P and Ferrera C designed the study; Martínez-Losas P, Nogales-Romo MT, Salinas P and Ferrera C participated in the follow up; all authors participated in clinical and/or interventional care, prospective data acquisition and realized a critical revision of the manuscript; Martínez Losas P, Salinas P, Ferrera C, Nogales-Romo MT and Viana-Tejedor A revised the final version.
Institutional review board statement: The institutional ethics review committee approved the retrospective anonymous analysis of the patients, in accordance with European guidelines for good clinical practice.
Informed consent statement: All patients’ relatives signed informed consents for the clinical procedures performed during admission. No special tests were done for this study. Therefore, no specific informed consent was obtained for this anonymous observational study.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Technical details and statistical methods are available from the corresponding author at salinas.pablo@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pablo Salinas, MD, PhD, Interventional Cardiology, Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Ciudad Universitaria, Professor Martin Lagos SN, 28040 Madrid, Spain. pablo.salinas@salud.madrid.org
Telephone: +34-91-3303220 Fax: +34-91-3303291
Received: November 10, 2016
Peer-review started: November 10, 2016
First decision: February 17, 2017
Revised: March 15, 2017
Accepted: June 6, 2017
Article in press: June 8, 2017
Published online: August 26, 2017
Abstract
AIM

To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.

METHODS

From March 2004 to February 2016, 203 consecutive patients resuscitated from in or out-of-hospital sudden cardiac arrest and non-diagnostic post-resuscitation electrocardiogram (defined as ST segment elevation or pre-sumably new left bundle branch block) who underwent invasive coronary angiogram during hospitalization were included. For purpose of analysis and comparison, patients were classified in two groups: Initial shockable rhythm (ventricular tachycardia or ventricular fibrillation; n = 148, 72.9%) and initial non-shockable rhythm (n = 55, 27.1%). Baseline characteristics, coronary angiogram findings including Syntax Score and long-term survival rates were compared.

RESULTS

Sudden cardiac arrest was witnessed in 95.2% of cases, 66.7% were out-of-hospital patients and 72.4% were male. There were no significant differences in baseline characteristics between groups except for higher mean age (68.1 years vs 61 years, P = 0.001) in the non-shockable rhythm group. Overall 5-year mortality of the resuscitated patients was 37.4%. Patients with non-shockable rhythms had higher mortality (60% vs 29.1%, P < 0.001) and a worst neurological status at hospital discharge based on cerebral performance category score (CPC 1-2: 32.7% vs 53.4%, P = 0.02). Although there were no significant differences in global burden of coronary artery disease defined by Syntax Score (mean Syntax Score: 10.2 vs 10.3, P = 0.96) there was a trend towards a higher incidence of acute coronary lesions in patients with shockable rhythm (29.7% vs 16.4%, P = 0.054). There was also a higher need for ad-hoc percutaneous coronary intervention in this group (21.9% vs 9.1%, P = 0.03).

CONCLUSION

Initial shockable group of patients had a trend towards higher incidence of acute coronary lesions and higher need of ad-hoc percutaneous intervention vs non-shockable group.

Keywords: Sudden cardiac arrest, Electrocardiogram, Invasive coronary angiography, Percutaneous coronary intervention, Syntax score, Coronary artery disease

Core tip: Coronary artery disease represents the most common cause of sudden cardiac arrest. Current re-suscitation guidelines recommend emergency coronary angiography in patients with cardiac arrest and ST elevation or new left bundle branch block on post-resuscitation electrocardiogram. However, electrocardiogram findings may be a poor predictor of an acute coronary lesion in this context and nowadays, the benefit of early coronary angiography is still under debate in patients without ST elevation. In this study, we analyzed our single-center data of patients with cardiac arrest and non-diagnostic electrocardiogram to describe the burden of coronary artery disease and their prognosis depending on initial rhythm.