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Hemodynamic instability not predictive of fatal outcomes in non-STEMI out-of-hospital cardiac arrest

27 Feb 2023

Out-of-hospital cardiac arrest (OHCA) continues to be a leading cause of death worldwide. Nearly 70% of these patients have relevant coronary artery disease. However, in OHCA patients without ST-segment elevation, acute coronary lesions are less frequent findings. Furthermore, these lesions are not reliably predicted by electrocardiography changes or by troponin values.

Current guidelines recommend differing angiography strategies in OHCA patients without ST-segment elevation, based on hemodynamic stability status. Guidelines dictate immediate coronary angiography (CAG) for hemodynamically unstable patients, while endorsing a delayed strategy for stable patients.

Investigators aimed to assess the frequency and predictors of acute coronary occlusion in hemodynamically stable and unstable OHCA patients without ST-segment elevation. They then examined the impact of these parameters on all-cause and cardiovascular (CV) death at 1 year. Researchers analyzed 386 consecutive OHCA patients without ST-segment elevation undergoing CAG at a hospital in Switzerland, between 2011 and 2019.

Coronary occlusions predicted by chest pain and shockable rhythms in out-of-hospital cardiac arrest

Over half of the patients were hemodynamically unstable; only 169 (43.8%) were deemed hemodynamically stable. CAG identified acute coronary occlusions in approximately 1 in 5 patients who had suffered OHCA. The frequency of these occlusions did not differ between stable and unstable patients. Acute coronary occlusions were associated with an increased risk of CV death (adjusted hazard ratio [HR], 2.74; 95% CI 1.22-6.15), but not all-cause death. Investigators discovered that initial chest pain and shockable rhythms predicted the presence of acute coronary occlusion. Interestingly, there was no correlation between hemodynamic instability and fatal outcomes.

Investigators concluded that in OHCA patients without ST-segment elevation, chest pain or shockable rhythm rather than hemodynamic status is predictive of acute coronary occlusion.

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Author: Kelly Schoonderwoerd

Original Article: Spirito A et al. J Am Coll Cardiol. 2023;81(5):446-456.

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