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

Florence Leclercq; Clément Lonjon; Grégory Marin; Mariama Akodad; François Roubille; Jean-Christophe Macia; Luc Cornillet; Richard Gervasoni; Laurent Schmutz; Bertrand Ledermann; Pascal Colson; Guillaume Cayla; Benoit Lattuca

doi:10.1016/j.ijcard.2020.03.037

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

Int J Cardiol. 2020 Jul 1:310:73-79. doi: 10.1016/j.ijcard.2020.03.037. Epub 2020 Mar 19.

Authors

Affiliations

¹ University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France. Electronic address: f-leclercq@chu-montpellier.fr.
² Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
³ Department of Epidemiology, Medical Statistics and Public Health, Arnaud de Villeneuve University Hospital, Montpellier, France. Electronic address: g-marin@chu-montpellier.fr.
⁴ University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France.
⁵ University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France. Electronic address: f-roubille@chu-montpellier.fr.
⁶ University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France. Electronic address: jc-macia@chu-montpellier.fr.
⁷ Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France. Electronic address: luc.cornillet@chu-nimes.fr.
⁸ University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France. Electronic address: r-gervasoni@chu-montpellier.fr.
⁹ Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France. Electronic address: laurent.schmutz@chu-nimes.fr.
¹⁰ Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France. Electronic address: bertrand.ledermann@chu-nimes.fr.
¹¹ Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, Montpellier, France.. Electronic address: p-colson@chu-montpellier.fr.
¹² Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France. Electronic address: guillaume.cayla@chu-nimes.fr.
¹³ Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France. Electronic address: benoit.lattuca@chu-nimes.fr.

PMID: 32295717
DOI: 10.1016/j.ijcard.2020.03.037

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.

MeSH terms

Cardiopulmonary Resuscitation*
Coronary Angiography
Electrocardiography
Humans
Out-of-Hospital Cardiac Arrest* / diagnostic imaging
Out-of-Hospital Cardiac Arrest* / therapy
Prospective Studies
Treatment Outcome