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Review
. 2022 Nov 25;2(1):100536.
doi: 10.1016/j.jscai.2022.100536. eCollection 2023 Jan-Feb.

Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation on Electrocardiograms: A Comprehensive Review

Sachin Kumar  1 , Bahaa Abdelghaffar  1 , Meghana Iyer  2 , Ghaith Shamaileh  3 , Raunak Nair  1 , Weili Zheng  1 , Beni Verma  1 , Venu Menon  1 , Samir R Kapadia  1 , Grant W Reed  1
Affiliations
Review

Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation on Electrocardiograms: A Comprehensive Review

Sachin Kumar et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Out-of-hospital cardiac arrest (OHCA) is among the most common causes of death in the United States. Early coronary angiography (CAG) and percutaneous coronary intervention (PCI) have been associated with improved long-term outcomes in patients with ST-segment elevation (STE) on prearrest or postarrest electrocardiograms. However, data on the utility of catheterization and PCI for improving outcomes after OHCA in patients without STE on electrocardiograms are heterogeneous, with variable results. Although older data have suggested that there is a benefit, recent randomized controlled trials have demonstrated that performing early CAG in patients with OHCA without STE on electrocardiograms may not improve outcomes. In recognition that neurologic devastation and multiorgan failure are common in these patients, physicians face the challenge of selecting appropriate patients for cardiac catheterization and PCI. This review aims to summarize the current data on this topic, with the goal to guide decision making regarding the timing and appropriateness of CAG in patients with OHCA without STE on electrocardiograms, utilizing an evidence-based approach to streamline the patient selection process.

Keywords: ST-segment elevation; cardiac cath lab; coronary angiography; out-of-hospital cardiac arrest; percutaneous coronary intervention; shockable rhythm.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Prevalence of acute coronary occlusion and significant coronary artery disease in successfully resuscitated patients with out-of-hospital cardiac arrest. Significant coronary artery disease defined as >70% stenosis in at least 1 major epicardial coronary vessel. ACS, acute coronary syndrome; CAD, coronary artery disease; OHCA, out-of-hospital cardiac arrest; ROSC, return of spontaneous circulation; STE, ST-segment elevation.
Figure 2
Figure 2
High-level evidence for the timing of coronary angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation on an electrocardiogram. As depicted, no randomized controlled trial published to date has shown that immediate coronary angiography is superior to delayed coronary angiography.
Central Illustration
Central Illustration
“Assess, Consult& Expect” (ACE) approach for patients with out-of-hospital cardiac arrest without ST-segment elevation on electrocardiograms. The ACE approach may serve as a conceptual framework for the management of patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation (STE) on electrocardiograms. CAD, coronary artery disease; CAG, coronary angiography; ECG, electrocardiogram; LVEF, left ventricle ejection fraction; ROSC, return of spontaneous circulation.
See this image and copyright information in PMC

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