Author + information
- Received October 14, 2014
- Revision received January 27, 2015
- Accepted February 12, 2015
- Published online July 1, 2015.
- Karl B. Kern, MD∗∗ (, )
- Kapildeo Lotun, MD∗,
- Nainesh Patel, MD†,
- Michael R. Mooney, MD‡,
- Ryan D. Hollenbeck, MD§,
- John A. McPherson, MD§,
- Paul W. McMullan, MD‖,
- Barbara Unger, RN‡,
- Chiu-Hsieh Hsu, PhD∗,
- David B. Seder, MD¶,
- INTCAR-Cardiology Registry
- ∗Sarver Heart Center, University of Arizona, Tucson, Arizona
- †Lehigh Valley Health Network, Allentown, Pennsylvania
- ‡Minneapolis Heart Institute, Minneapolis, Minnesota
- §Vanderbilt University Medical Center, Nashville, Tennessee
- ‖Saint Thomas Heart, Nashville, Tennessee
- ¶Maine Medical Center, Portland, Maine
- ↵∗Reprint requests and correspondence:
Dr. Karl B. Kern, Division of Cardiology, Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, Arizona 85724.
Objectives The aim of this study was to compare outcomes and coronary angiographic findings in post–cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI).
Background The 2013 STEMI guidelines recommend performing immediate angiography in resuscitated patients whose initial electrocardiogram shows STEMI. The optimal approach for those without STEMI post–cardiac arrest is less clear.
Methods A retrospective evaluation of a post–cardiac arrest registry was performed.
Results The database consisted of 746 comatose post–cardiac arrest patients including 198 with STEMI (26.5%) and 548 without STEMI (73.5%). Overall survival was greater in those with STEMI compared with those without (55.1% vs. 41.3%; p = 0.001), whereas in all patients who underwent immediate coronary angiography, survival was similar between those with and without STEMI (54.7% vs. 57.9%; p = 0.60). A culprit vessel was more frequently identified in those with STEMI, but also in one-third of patients without STEMI (80.2% vs. 33.2%; p = 0.001). The majority of culprit vessels were occluded (STEMI, 92.7%; no STEMI, 69.2%; p < 0.0001). An occluded culprit vessel was found in 74.3% of STEMI patients and in 22.9% of no STEMI patients. Among cardiac arrest survivors discharged from the hospital who had presented without STEMI, coronary angiography was associated with better functional outcome (93.3% vs. 78.7%; p < 0.003).
Conclusions Early coronary angiography is associated with improved functional outcome among resuscitated patients with and without STEMI. Resuscitated patients with a presumed cardiac etiology appear to benefit from immediate coronary angiography.
This research was funded in part by a grant from the Steven M. Gootter Foundation, Tucson, Arizona. Dr. Lotun is on the Speakers Bureau of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 14, 2014.
- Revision received January 27, 2015.
- Accepted February 12, 2015.
- 2015 American College of Cardiology Foundation