Coronary angiographic findings after cardiac arrest in relation to ECG and comorbidity



      The relations between specific ECG patterns and coronary angiographic findings in cardiac arrest patients with different comorbidities are not properly assessed. More evidence is needed to identify patients with the highest risk for acute coronary artery disease as a cause of the cardiac arrest. This study aims to describe the coronary artery findings after cardiac arrest in relation to ECG and comorbidity.


      A retrospective study of out-of-hospital cardiac arrest patients, with coronary angiography performed within 28 days. ECG on admission, comorbidity, PCI attempts and angiographic findings are described. Data were retrieved from national registries in Sweden.


      Among 1133 patients with available ECG and angiography information the mean age was 64 years. The rate of shockable rhythm was 79%. The total incidence of any significant stenosis in cardiac arrest patients without ST-elevation who underwent coronary angiography within 28 days was 71%. The incidence of any stenosis in patients with normal ECG was 62.1% and in patients with LBBB, 59.3%. In patients with ST-depression or RBBB, PCI attempts were made in 47.1% and 42.4% respectively, compared with 33.3% in patients with normal ECG. Among patients without ST-elevation, those with diabetes mellitus and those with initial shockable rhythm respectively, 84.8% and 71.5 had at least one significant stenosis.


      Our study suggests, that evaluation of ECG patterns and comorbidities in out-of-hospital cardiac arrest patients without ST-segment elevation may be important to identify those with a high risk of coronary artery lesions that could benefit from early revascularization.


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        • Nolan J.P.
        • Soar J.
        • Cariou A.
        • et al.
        European resuscitation council and European society of intensive care medicine guidelines for post-resuscitation care 2015: section 5 of the European resuscitation council guidelines for resuscitation 2015.
        Resuscitation. 2015; 95: 202-222
        • Anyfantakis Z.A.
        • Baron G.
        • Aubry P.
        • et al.
        Acute coronary angiographic findings in survivors of out-of-hospital cardiac arrest.
        Am Heart J. 2009; 157: 312-318
        • Dumas F.
        • Cariou A.
        • Manzo-Silberman S.
        • et al.
        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.
        Circulation Cardiovasc Interv. 2010; 3: 200-207
        • Spaulding C.M.
        • Joly L.-M.
        • Rosenberg A.
        • et al.
        Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.
        New Engl J Med. 1997; 336: 1629-1633
        • Zanuttini D.
        • Armellini I.
        • Nucifora G.
        • et al.
        Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest.
        Resuscitation. 2013; 84: 1250-1254
        • Hollenbeck R.D.
        • McPherson J.A.
        • Mooney M.R.
        • et al.
        Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI.
        Resuscitation. 2014; 85: 88-95
        • Staer-Jensen H.
        • Nakstad E.R.
        • Fossum E.
        • et al.
        Post-resuscitation ECG for selection of patients for immediate coronary angiography in out-of-hospital cardiac arrest.
        Circulation Cardiovasc Interv. 2015; 8
        • Lemkes J.S.
        • Janssens G.N.
        • van der Hoeven N.W.
        • et al.
        Coronary angiography after cardiac arrest without ST-segment elevation.
        New Engl J Med. 2019;
        • Ibanez B.
        • James S.
        • Agewall S.
        • et al.
        2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2018; 39: 119-177
        • Radsel P.
        • Knafelj R.
        • Kocjancic S.
        • Noc M.
        Angiographic characteristics of coronary disease and postresuscitation electrocardiograms in patients with aborted cardiac arrest outside a hospital.
        Am J Cardiol. 2011; 108: 634-638
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • et al.
        Fourth universal definition of myocardial infarction (2018).
        Eur Heart J. 2019; 40: 237-269
        • Surawicz B.
        • Childers R.
        • Deal B.J.
        • et al.
        AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology.
        J Am Col Cardiol. 2009; 53: 976-981
        • Millin M.G.
        • Comer A.C.
        • Nable J.V.
        • et al.
        Patients without ST elevation after return of spontaneous circulation may benefit from emergent percutaneous intervention: a systematic review and meta-analysis.
        Resuscitation. 2016; 108: 54-60
        • Dankiewicz J.
        • Nielsen N.
        • Annborn M.
        • et al.
        Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography: a post hoc analysis from the TTM trial.
        Intensive Care Med. 2015; 41: 856-864
        • Elfwen L.
        • Lagedal R.
        • James S.
        • et al.
        Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival.
        Am Heart J. 2018; 200: 90-95
        • Lagedal R.
        • Elfwen L.
        • James S.
        • et al.
        Design of DISCO-direct or subacute coronary angiography in out-of-hospital cardiac arrest study.
        Am Heart J. 2018; 197: 53-61
        • Lemkes J.S.
        • Janssens G.N.
        • Straaten H.M.
        • et al.
        Coronary angiography after cardiac arrest: rationale and design of the COACT trial.
        Am Heart J. 2016; 180: 39-45