Key result
Prearrest chest discomfort was independently associated with significant coronary artery lesions on postarrest angiography in out-of-hospital cardiac arrest survivors (aOR 4.8; 95% CI 2.1-11.8).
Why the study?
Substantial uncertainty exists regarding patient selection for postarrest coronary angiography following out-of-hospital cardiac arrest.
Are prearrest symptoms such as chest discomfort associated with significant coronary lesions on postarrest coronary angiography in survivors of out-of-hospital cardiac arrest?
Cohort (n=400)
Yes
Are prearrest symptoms such as chest discomfort associated with significant coronary lesions on postarrest coronary angiography in survivors of out-of-hospital cardiac arrest?
Odds Ratio: 4.8 (95% CI 2.1–11.8)
p-value: p=≤0.001
Prearrest chest discomfort is strongly associated with significant coronary lesions in OHCA survivors, suggesting its utility in risk-stratifying patients for invasive angiography.
Pre-arrest ACS symptoms may identify candidates for postarrest CAG; leaves open whether this refines selection or improves outcomes in registry data.
OBJECTIVES: Out-of-hospital cardiac arrest (OHCA) afflicts >350,000 people annually in the United States. While postarrest coronary angiography (CAG) with percutaneous coronary intervention (PCI) has been associated with improved survival in observational cohorts, substantial uncertainty exists regarding patient selection for postarrest CAG. We tested the hypothesis that symptoms consistent with acute coronary syndrome (ACS), including chest discomfort, prior to OHCAs are associated with significant coronary lesions identified on postarrest CAG. METHODS: We conducted a multicenter retrospective cohort study among eight regional hospitals. Adult patients who experienced atraumatic OHCA with successful initial resuscitation and subsequent CAG between January 2015 and December 2019 were included. We collected data on prehospital documentation of potential ACS symptoms prior to OHCA as well as clinical factors readily available during postarrest care. The primary outcome in multivariable regression modeling was the presence of significant coronary lesions (defined as >50% stenosis of left main or >75% stenosis of other coronary arteries). RESULTS: Four-hundred patients were included. Median (interquartile range) age was 59 (51-69) years; 31% were female. At least one significant stenosis was found in 62%, of whom 71% received PCI. Clinical factors independently associated with a significant lesion included a history of myocardial infarction (adjusted odds ratio [aOR] = 6.5, [95% confidence interval {CI} = 1.3 to 32.4], p = 0.02), prearrest chest discomfort (aOR = 4.8 [95% CI = 2.1 to 11.8], p ≤ 0.001), ST-segment elevations (aOR = 3.2 [95% CI = 1.7 to 6.3], p < 0.001), and an initial shockable rhythm (aOR = 1.9 [95% CI = 1.0 to 3.4], p = 0.05). CONCLUSIONS: Among survivors of OHCA receiving CAG, history of prearrest chest discomfort was significantly and independently associated with significant coronary artery lesions on postarrest CAG. This suggests that we may be able to use prearrest symptoms to better risk stratify patients following OHCA to decide who will benefit from invasive angiography.
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Helfer et al. (2021) conducted a cohort in Out-of-hospital cardiac arrest (n=400). Prearrest chest discomfort vs. Absence of prearrest chest discomfort was evaluated on Presence of significant coronary lesions (>50% stenosis of left main or >75% stenosis of other coronary arteries) (aOR 4.8, 95% CI 2.1 to 11.8, p=≤0.001). Prearrest chest discomfort was independently associated with significant coronary artery lesions on postarrest angiography in out-of-hospital cardiac arrest survivors (aOR 4.8; 95% CI 2.1-11.8).
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