Danilo Franco (Author), Tomaž Goslar (Author), Peter Radšel (Author), Nicola De Luca (Author), Giovanni Esposito (Author), Raffaele Izzo (Author), Tullio Tesorio (Author), Emanuele Barbato (Author), Marko Noč (Author)

Abstract

Aim: We hypothesized that adult patients with out-of-hospital cardiac arrest (OHCA) and ST-elevation myocardial infarction (STEMI) requiring prolonged resuscitation have more severe coronary artery disease (CAD) than those responding rapidly, and more severe CAD than patients with STEMI without OHCA. Methods: Consecutive conscious and comatose OHCA patients with STEMI after reestablishment of spontaneous circulation (ROSC), and patients with refractory OHCA undergoing veno-arterial extracorporeal membrane oxygenation (E-CPR OHCA) were compared to STEMI without OHCA (STEMI no OHCA). CAD severity was assessed by a single physician blinded to the resuscitation method, time to ROSC and level of consciousness. Results: Between 2016 and 2022, 71 conscious OHCA, 157 comatose OHCA, 50 E-CPR OHCA and 101 STEMI no OHCA underwent immediate coronary angiography. Acute culprit lesion was documented less often in OHCA (88.1% vs 97%; p = 0.009) but complete occlusion was more frequent (68.8% vs 58.4%; p = 0.038) than in STEMI no OHCA. SYNTAX score was 5.6 in STEMI no OHCA, 10.2 in conscious OHCA, 13.4 in comatose OHCA and 26.8 in E-CPR OHCA (p < 0.001). There was a linear correlation between SYNTAX score and delay to ROSC/ECMO initiation (r2 = 0.61; p < 0.001). Post PCI culprit TIMI 3 flow was comparable between the groups (≥86%). SYNTAX score was among independent predictors of 5-year survival which was significantly decreased in comatose OHCA (56.1%) and E-CPR OHCA (36.0%) compared to conscious OHCA (83.1%) and STEMI no OHCA (88.1%). Conclusion: Compared to STEMI no OHCA, OHCA was associated with increased incidence of acute coronary occlusion and more complex non culprit CAD which progressively increased from conscious OHCA to E-CPR OHCA. Severity of CAD was associated with increased delays to ROSC/ECMO initiation and decreased long term survival.

Keywords

out-of-hospital cardiac arrest;coronary angiography;E-CPR;chest compression;

Data

Language: English
Year of publishing:
Typology: 1.01 - Original Scientific Article
Organization: UL MF - Faculty of Medicine
UDC: 616-083.98
COBISS: 201651459 Link will open in a new window
ISSN: 1873-1570
Views: 95
Downloads: 27
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Other data

Secondary language: Slovenian
Secondary keywords: srčni zastoj zunaj bolnišnice;koronarna angiografija;E-CPR;
Type (COBISS): Article
Pages: str. 1-7
Volume: ǂVol. ǂ193
Issue: ǂ[article no.] ǂ109981
Chronology: 2023
DOI: 10.1016/j.resuscitation.2023.109981
ID: 24511955