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Prevalence of coronary artery disease in patients after cardiac arrest without ST elevations at hospital admission. A retrospective cohort analysis

Session Poster Session 1

Speaker Matthias Mueller

Congress : Acute Cardiovascular Care 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Cardiac Care - Resuscitation
  • Session type : Poster Session
  • FP Number : P239

Authors : M Mueller (Vienna,AT), D Dziekan (Vienna,AT), M Poppe (Vienna,AT), C Clodi (Vienna,AT), C Schriefl (Vienna,AT), C Roth (Vienna,AT), A Nuernberger (Vienna,AT), M Holzer (Vienna,AT), C Weiser (Vienna,AT)

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Authors:
M Mueller1 , D Dziekan1 , M Poppe1 , C Clodi1 , C Schriefl1 , C Roth2 , A Nuernberger1 , M Holzer1 , C Weiser1 , 1Medical University of Vienna, Department of Emergency Medicine - Vienna - Austria , 2Medical University of Vienna, Department of Cardiology - Vienna - Austria ,

Citation:

Background: Coronary artery disease (CAD) is the most common cause for out of hospital cardiac arrest (OHCA) which affects up to 700 000 individuals in Europe every year. Nonetheless in patients without ST-elevations (STE) after sustained return of spontaneous circulation (ROSC), necessity of coronary angiography (CAG) is still discussed controversial. 

Purpose: The purpose of this study is to report the prevalence of treatable CAD and outcomes for resuscitated patients without STE at hospital admission. 

Methods: Retrospective OHCA database analysis from 2005 to 2015 in a tertiary care center. All OHCA patients > 18 years with presumed cardiac cause and sustained ROSC without STE at admission were included. Primary endpoint was defined as good neurological survival at 30 days after ROSC. 

Based on coronary arteries examination results, patients were categorized in ‘manifest CAD’ or ‘no manifest CAD’. 

Results: During the study period 645 (55.1%) out of 1170 screened patients could be included. Coronary angiography was done in 343 (53.2%) patients. Manifest CAD was found in 214 (62.4%) patients. Coronary intervention, thrombus aspiration or coronary artery bypass grafting were feasible in 152 (71.0%) patients. Detailed baseline characteristics are expressed in table 1. 

The highest survival rates were found in the ‘no manifest CAD’ group (90.7%), although survival for patients with ‘manifest CAD’ (76.6%, p<0.001) was also higher than without CAG (44.7%, p<0.001).

Conclusions: The high prevalence of CAD and a rather high rate of successful coronary interventions emphasizes the recommendations to catheterize all patients without ST-elevations in the absence of obvious non-cardiac causes immediately.

Manifest CAD (n=214) No manifest CAD (n=129) p-value
Age, years (IQR) 60 (52-68) 59 (48-69) 0.253
Male sex, n (%) 181 (84,6) 101 (78.3) 0.140
Initial shockable, n (%) 181 (84.6) 92 (71.3) 0.003
Arrest witnessed, n (%) 193 (90.2) 120 (93.0) 0.368
Bystander CPR, n (%) 83 (38.8) 68 (52.7) 0.012
Time to ROSC, minutes (IQR) 15 (6-23) 15 (8-25) 0.625
Lactate at admission (IQR) 6.1 (3.7-8.2) 5.5 (3.6-7.8) 0.535

Troponin T at admission in µg/l (IQR)

0.057 (0.020-0.206) 0.040 (0.020-0.105) 0.046
Cerebral performance category 1-2 after 30 days 133/164 (81.1) 108/117 (92.3) 0.001


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