Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul 1:310:73-79.
doi: 10.1016/j.ijcard.2020.03.037. Epub 2020 Mar 19.

Post resuscitation electrocardiogram for coronary angiography indication after out-of-hospital cardiac arrest

Florence Leclercq  1 , Clément Lonjon  2 , Grégory Marin  3 , Mariama Akodad  4 , François Roubille  5 , Jean-Christophe Macia  6 , Luc Cornillet  7 , Richard Gervasoni  8 , Laurent Schmutz  9 , Bertrand Ledermann  10 , Pascal Colson  11 , Guillaume Cayla  12 , Benoit Lattuca  13
Affiliations

Post resuscitation electrocardiogram for coronary angiography indication after out-of-hospital cardiac arrest

Florence Leclercq et al. Int J Cardiol. .

Abstract

Background: Coronary angiography is the standard of care after Out-of-Hospital Cardiac Arrest (OHCA), but its benefit for patients without persistent ST-segment elevation (STE) remains controversial.

Methods: All patients admitted for coronary angiography after a resuscitated OHCA were consecutively included in this prospective study. Three patient groups were defined according to post-resuscitation ECG: STE or new left bundle branch block (LBBB) (group 1); other ST/T repolarization disorders (group 2) and no repolarisation disorders (group 3). The proportion and predictive factors of an acute coronary lesion, defined by acute coronary occlusion or thrombotic lesion or lesion associated with flow impairment, were evaluated according to different groups as well as thirty-day mortality.

Results: Among 129 consecutive patients: 62 (48.1%), 30 (23.3%) and 30 (23.3%) patients were included in groups 1, 2 and 3 respectively. An acute coronary lesion was observed in 43% (n = 55) of patients, mainly in group 1 (n = 44, 70.9%). Initial coronary TIMI 0/1 flow was more frequently observed in group 1 than in group 2 (n = 25, 40.3% vs n = 1, 3.3%) and never in group 3. Chest pain and STE or new LBBB were independently associated with an acute coronary lesion (adj. OR = 7.14 [1.85-25.00]; p = 0.004 and adj. OR = 11.10 [3.70-33.33]; p < 0.001 respectively). In absence of any repolarization disorders, acute coronary lesion or occlusion were excluded with negative predictive values of 93.3% and 100% respectively. The one-month survival rate was 38.8% and was better in patients among the group 1 compared to those from the 2 other groups (n = 28, 45.2% vs n = 21, 35%, respectively; p = 0.014).

Conclusion: Considering the high negative predictive value of post-resuscitation ECG to exclude acute coronary lesion and occlusion after OHCA, a delayed coronary angiography appears a reliable alternative for patients without repolarization disorders.

Keywords: Cardiac arrest; Coronary angiography; ECG; Mortality; Repolarization disorders; Resuscitation.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest F. Leclercq has received research Grants from Boehringer Ingelheim, Edwards Lifesciences, Medtronic and consultant fees from Bayer AG, Boehringer Ingelheim and Edwards Lifesciences. M. Akodad has received research grants from Edwards Lifescience and Medtronic. G. Cayla has received research Grants or Consulting/Lecture Fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Biotronik, Bristol-Myers Squibb, Daiichi-Sankyo, Eli-Lilly, Medtronic, MSD, Pfizer, Sanofi-Aventis. B. Lattuca has received research grants from Biotronik, Boston Scientific, Daiichi-Sankyo, Fédération Française de Cardiologie and Institute of CardioMetabolism and Nutrition; consultant fees from Daiichi-Sankyo and Eli Lilly; and lecture fees from AstraZeneca, Medtronic and Novartis. C. Lonjon, G. Marin, F. Roubille, JC. Macia, L. Cornillet, R. Gervasoni, L. Schmutz, B. Ledermann and P. Colson report no conflicts of interest in this work.

MeSH terms

LinkOut - more resources