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. 2023 Feb 7;81(5):446-456.
doi: 10.1016/j.jacc.2022.10.039.

Acute Coronary Occlusion in Patients With Non-ST-Segment Elevation Out-of-Hospital Cardiac Arrest

Alessandro Spirito  1 , Lukas Vaisnora  2 , Athanasios Papadis  2 , Fortunato Iacovelli  3 , Celestino Sardu  4 , Alexandra Selberg  5 , Sarah Bär  2 , Raminta Kavaliauskaite  2 , Fabrice Temperli  2 , Babken Asatryan  2 , Thomas Pilgrim  2 , Lukas Hunziker  2 , Dik Heg  6 , Marco Valgimigli  7 , Stephan Windecker  2 , Lorenz Räber  8
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Free article

Acute Coronary Occlusion in Patients With Non-ST-Segment Elevation Out-of-Hospital Cardiac Arrest

Alessandro Spirito et al. J Am Coll Cardiol. .
Free article

Abstract

Background: According to current guidelines, hemodynamic status should guide the decision between immediate and delayed coronary angiography (CAG) in out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation. A delayed strategy is advised in hemodynamically stable patients, and an immediate approach is recommended in unstable patients.

Objectives: This study sought to assess the frequency, predictors, and clinical impact of acute coronary occlusion in hemodynamically stable and unstable OHCA patients without ST-segment elevation.

Methods: Consecutive unconscious OHCA patients without ST-segment elevation who were undergoing CAG at Bern University Hospital (Bern, Switzerland) between 2011 and 2019 were included. Frequency and predictors of acute coronary artery occlusions and their impact on all-cause and cardiovascular mortality at 1 year were assessed.

Results: Among the 386 patients, 169 (43.8%) were hemodynamically stable. Acute coronary occlusions were found in 19.5% of stable and 24.0% of unstable OHCA patients (P = 0.407), and the presence of these occlusions was predicted by initial chest pain and shockable rhythm, but not by hemodynamic status. Acute coronary occlusion was associated with an increased risk of cardiovascular death (adjusted HR: 2.74; 95% CI: 1.22-6.15) but not of all-cause death (adjusted HR: 0.72; 95% CI: 0.44-1.18). Hemodynamic instability was not predictive of fatal outcomes.

Conclusions: Acute coronary artery occlusions were found in 1 in 5 OHCA patients without ST-segment elevation. The frequency of these occlusions did not differ between stable and unstable patients, and the occlusions were associated with a higher risk of cardiovascular death. In OHCA patients without ST-segment elevation, chest pain or shockable rhythm rather than hemodynamic status identifies patients with acute coronary occlusion.

Keywords: coronary angiography; coronary occlusion; death; non–ST-segment elevation; out-of-hospital cardiac arrest.

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Conflict of interest statement

Funding Support and Author Disclosures This study was supported by the Department of Cardiology at Bern University Hospital, Bern, Switzerland. Dr Spirito has received a research grant from the Swiss National Science Foundation. Dr Bär has received research grants from Medis Medical Imaging Systems, Abbott, Bangerter-Rhyner-Stiftung, and the Swiss National Science Foundation, outside the submitted work. Dr Valgimigli has received personal fees from AstraZeneca, Alvimedica/CID, Abbott Vascular, Daiichi-Sankyo, Bayer, CoreFLOW, Idorsia Pharmaceuticals, University of Basel Clinical Research Department, Vifor, Bristol Myers Squibb, Biotronik, Boston Scientific, Medtronic, Vesalio, Novartis, Chiesi, and PhaseBio; and has received grants and personal fees from Terumo, outside the submitted work. Dr Windecker has received research and educational grants to the institution from Abbott, Amgen, AstraZeneca, Bristol Myers Squibb, Bayer, Biotronik, Boston Scientific, Cardinal Health, CardioValve, CSL Behring, Daiichi-Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Johnson & Johnson, Medicure, Medtronic, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron, Sanofi, Sinomed, Terumo, and V-Wave; has served as an unpaid advisory board member and/or unpaid member of the steering or executive group of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, Bayer. Bristol Myers Squibb, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, Janssen, MedAlliance, Medtronic, Novartis, Polares, Recardio, Sinomed, Terumo, V-Wave, and Xeltis but has not received personal payments from pharmaceutical companies or device manufacturers; and is a member of the steering or executive committee group of several investigator-initiated trials that receive funding from industry without an impact on his personal remuneration. Dr Räber has received research grants to the institution from Abbott, Biotronik, Boston Scientific, Heartflow, Sanofi, and Regeneron; and has received speaker or consultation fees from Abbott, Amgen, AstraZeneca, Canon, Medtronic, NovoNordisk, Occlutech, and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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