Abstract
Introduction
The American Heart Association recommends that post-arrest patients with evidence
of ST elevation myocardial infarction (STEMI) on electrocardiogram (ECG) be emergently
taken to the catheterization lab for percutaneous coronary intervention (PCI). However,
recommendations regarding the utility of emergent PCI for patients without ST elevation
are less specific. This review examined the literature on the utility of PCI in post-arrest
patients without ST elevation compared to patients with STEMI.
Methods
A systematic review of the English language literature was performed for all years
to March 1, 2015 to examine the hypothesis that a percentage of post-cardiac arrest
patients without ST elevation will benefit from emergent PCI as defined by evidence
of an acute culprit coronary lesion.
Results
Out of 1067 articles reviewed, 11 articles were identified that allowed for analysis
of data to examine our study hypothesis. These studies show that patients presenting
post cardiac arrest with STEMI are thirteen times more likely to be emergently taken
to the catheterization lab than patients without STEMI; OR 13.8 (95% CI 4.9–39.0).
Most importantly, the cumulative data show that when taken to the catheterization
lab as much as 32.2% of patients without ST elevation had an acute culprit lesion
requiring intervention, compared to 71.9% of patients with STEMI; OR 0.15 (95% CI
0.06–0.34).
Conclusion
The results of this systematic review demonstrate that nearly one third of patients
who have been successfully resuscitated from cardiopulmonary arrest without ST elevation
on ECG have an acute lesion that would benefit from emergent percutaneous coronary
intervention.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American college of cardiology foundation/American heart association task force on practice guidelines.J Am Coll Cardiol. 2013; 61: e78-e140
- Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2015; 132: S465-S482
- Impact of routine percutaneous coronary intervention after out-of-hospital cardiac arrest due to ventricular fibrillation.Crit Care. 2011; 15: R122
- Long-term prognosis following resuscitation from out of hospital cardiac arrest: role of percutaneous coronary intervention and therapeutic hypothermia.J Am Coll Cardiol. 2012; 60: 21-27
- Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI.Resuscitation. 2014; 85: 88-95
- The prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.PLoS Med. 2009; 6: e1000100
- A quality-effects model for meta-analysis.Epidemiology. 2008; 19: 94-100
- The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928
- Predictive factors for positive coronary angiography in out-of-hospital cardiac arrest patients.Eur J Emerg Med. 2011; 18: 73-76
- Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) registry.Circ Cardiovasc Interv. 2010; 3: 200-207
- Angiographic characteristics of coronary disease and postresuscitation electrocardiograms in patients with aborted cardiac arrest outside a hospital.Am J Cardiol. 2011; 108: 634-638
- Favourable 5-year postdischarge survival of comatose patients resuscitated from out-of-hospital cardiac arrest, managed with immediate coronary angiogram on admission.Eur Heart J Acute Cardiovasc Care. 2014; 3: 183-191
- Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.N Engl J Med. 1997; 336: 1629-1633
- Impact of emergency coronary angiography on in-hospital outcome of unconscious survivors after out-of-hospital cardiac arrest.Am J Cardiol. 2012; 110: 1723-1728
- Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest.Resuscitation. 2013; 84: 1250-1254
- Ten-year experience of an invasive cardiology centre with out-of-hospital cardiac arrest patients admitted for urgent coronary angiography.Kardiol Pol. 2014; 72: 687-699
- Outcomes of comatose cardiac arrest survivors with and without ST-segment elevation myocardial infarction: importance of coronary angiography.JACC Cardiovasc Interv. 2015; 8: 1031-1040
- Early access to the cardiac catheterization laboratory for patients resuscitated from cardiac arrest due to a shockable rhythm: the minnesota resuscitation consortium twin cities unified protocol.J Am Heart Assoc. 2016; : 5
- Effect on survival of an early versus late coronary angiography approach in patients with out-of-hospital cardiac arrest wihtout ST-segment elevation myocardial infarction.Circulation American Heart Association’s 2014 Scientific Sessions and Resuscitation Science Symposium. 2014; : 130
- Cardiac arrest: a treatment algorithm for emergent invasive cardiac procedures in the resuscitated comatose patient.J Am Coll Cardiol. 2015; 66: 62-73
- Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (grace).BMJ. 2006; 333: 1091
- Early versus delayed invasive intervention in acute coronary syndromes.N Engl J Med. 2009; 360: 2165-2175
- Association between stroke center hospitalization for acute ischemic stroke and mortality.JAMA. 2011; 305: 373-380
- The volume-outcomes relationship for united states level I trauma centers.J Surg Res. 2011; 167: 19-23
- Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest.Resuscitation. 2010; 81: 549-554
- Value of post-resuscitation electrocardiogram in the diagnosis of acute myocardial infarction in out-of-hospital cardiac arrest patients.Resuscitation. 2011; 82: 1148-1153
- et al. Cardiac catheterization is underutilized after in-hospital cardiac arrest.Resuscitation. 2008; 79: 398-403
Article info
Publication history
Published online: September 15, 2016
Accepted:
September 5,
2016
Received in revised form:
August 30,
2016
Received:
March 3,
2016
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2016.09.004.
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
