Incidence of coronary intervention in cardiac arrest survivors with non-shockable initial rhythms and no evidence of ST-elevation MI (STEMI).

MedStar author(s):
Citation: Resuscitation. 113:83-86, 2017 AprPMID: 27888672Institution: MedStar Washington Hospital CenterDepartment: Emergency MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cardiopulmonary Resuscitation | *Coronary Angiography | *Electric Countershock | *Myocardial Infarction | *Out-of-Hospital Cardiac Arrest | *Percutaneous Coronary Intervention | Cardiopulmonary Resuscitation/mt [Methods] | Cardiopulmonary Resuscitation/sn [Statistics & Numerical Data] | Coronary Angiography/mt [Methods] | Coronary Angiography/sn [Statistics & Numerical Data] | Electric Countershock/mt [Methods] | Electric Countershock/sn [Statistics & Numerical Data] | Emergency Medical Services/mt [Methods] | Emergency Medical Services/sn [Statistics & Numerical Data] | Female | Heart Rate | Humans | Incidence | Male | Middle Aged | Myocardial Infarction/di [Diagnosis] | Myocardial Infarction/ep [Epidemiology] | Out-of-Hospital Cardiac Arrest/ep [Epidemiology] | Out-of-Hospital Cardiac Arrest/th [Therapy] | Outcome and Process Assessment (Health Care) | Percutaneous Coronary Intervention/mt [Methods] | Percutaneous Coronary Intervention/sn [Statistics & Numerical Data] | Registries/sn [Statistics & Numerical Data] | United States/ep [Epidemiology]Year: 2017ISSN:
  • 0300-9572
Name of journal: ResuscitationAbstract: CONCLUSIONS: In this large multi-center retrospective analysis there is a high incidence of coronary intervention in post-arrest patients with initially non-shockable rhythms and without STEMI on ECG who are taken for angiography.Copyright (c) 2016. Published by Elsevier B.V.METHODS: Retrospective multicenter US clinical registry study of post-cardiac arrest patients at 18 hospitals between 1/00 and 5/14. The incidence of significant coronary artery disease (CAD) as defined by documented coronary intervention (i.e. PCI, angioplasty, stent or CABG) was assessed.OBJECTIVE: With the demonstrated benefit of an early-invasive strategy for STEMI and VF/VT arrest patients, there is interest in assessing the potential benefit of early angiography for non-shockable (PEA/Asystole) arrest patients. We hypothesized that in cardiac arrest patients who obtain return of spontaneous circulation (ROSC) after a non-shockable initial rhythm and do not have STEMI the incidence of coronary intervention would be clinically insignificant (<5%).RESULTS: There were 1396 arrest patients with ROSC and known initial rhythms (517/1396=37% shockable; 879/1396=63% nonshockable). 440 (299/440=58% shockable; 141/440=32% nonshockable) of these patients received angiography. In the 141 non-shockable patients that received angiography, 97 patients did not have STEMI listed as an indication for catheterization and 24 (25%) of those had a coronary intervention documented yielding an observed incidence of coronary intervention in non-shockable post-arrest patients without STEMI who received angiography of 24.7% (24/97). Of note, the overall incidence of coronary intervention in all ROSC patients with non-shockable initial rhythms was 5.5% (48/879).All authors: Abella BS, Frohna W, Gaieski DF, Goyal M, Grossestreuer AV, Wilson MFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-05-06
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Journal Article MedStar Authors Catalog Article 27888672 Available 27888672

CONCLUSIONS: In this large multi-center retrospective analysis there is a high incidence of coronary intervention in post-arrest patients with initially non-shockable rhythms and without STEMI on ECG who are taken for angiography.

Copyright (c) 2016. Published by Elsevier B.V.

METHODS: Retrospective multicenter US clinical registry study of post-cardiac arrest patients at 18 hospitals between 1/00 and 5/14. The incidence of significant coronary artery disease (CAD) as defined by documented coronary intervention (i.e. PCI, angioplasty, stent or CABG) was assessed.

OBJECTIVE: With the demonstrated benefit of an early-invasive strategy for STEMI and VF/VT arrest patients, there is interest in assessing the potential benefit of early angiography for non-shockable (PEA/Asystole) arrest patients. We hypothesized that in cardiac arrest patients who obtain return of spontaneous circulation (ROSC) after a non-shockable initial rhythm and do not have STEMI the incidence of coronary intervention would be clinically insignificant (<5%).

RESULTS: There were 1396 arrest patients with ROSC and known initial rhythms (517/1396=37% shockable; 879/1396=63% nonshockable). 440 (299/440=58% shockable; 141/440=32% nonshockable) of these patients received angiography. In the 141 non-shockable patients that received angiography, 97 patients did not have STEMI listed as an indication for catheterization and 24 (25%) of those had a coronary intervention documented yielding an observed incidence of coronary intervention in non-shockable post-arrest patients without STEMI who received angiography of 24.7% (24/97). Of note, the overall incidence of coronary intervention in all ROSC patients with non-shockable initial rhythms was 5.5% (48/879).

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