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Coronary angiographic findings and outcomes in patients with sudden cardiac arrest without ST-elevation myocardial infarction : A SWEDEHEART study

Wester, Axel LU ; Mohammad, Moman A. LU ; Andell, Pontus LU ; Rylance, Rebecca LU ; Dankiewicz, Josef LU ; Friberg, Hans LU ; James, Stefan; Omerovic, Elmir; Erlinge, David LU and Koul, Sasha LU (2018) In Resuscitation 126. p.172-178
Abstract

Background/aim: Sudden cardiac arrest (SCA) has a substantial mortality rate and the acute coronary syndrome constitutes the major cause. Post-resuscitation electrocardiogram ST-elevation SCA (STE-SCA) is a strong indication for emergency coronary angiography, but the role of early angiography and PCI in patients without ST-elevation (NSTE-SCA) remains to be established. This paper aimed to describe this patient group and evaluate the prognostic effect of early PCI in a large nationwide cohort of NSTE-SCA patients undergoing coronary angiography. Methods: Data from SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) on 4308 SCA... (More)

Background/aim: Sudden cardiac arrest (SCA) has a substantial mortality rate and the acute coronary syndrome constitutes the major cause. Post-resuscitation electrocardiogram ST-elevation SCA (STE-SCA) is a strong indication for emergency coronary angiography, but the role of early angiography and PCI in patients without ST-elevation (NSTE-SCA) remains to be established. This paper aimed to describe this patient group and evaluate the prognostic effect of early PCI in a large nationwide cohort of NSTE-SCA patients undergoing coronary angiography. Methods: Data from SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) on 4308 SCA patients in Sweden between 2005 and 2016 were descriptively analyzed and related to mortality within 30-days in both unadjusted and adjusted analyses using Cox proportional hazard models. Results: NSTE-SCA patients had more often serious comorbidities than STE-SCA patients. Among NSTE-SCA patients, 36.4% had no significant coronary artery stenosis while severe coronary stenosis (≥90%) was present in 43.9% (1271/2896). In NSTE-SCA patients with significant stenosis (≥90%), PCI was performed in 59.2% (753/1271) with an increased unadjusted 30-day mortality (40.9% vs. 32.7%; p = .011). However, after adjustments for confounders, no difference in mortality was observed (hazard ratio 1.07; 95% CI 0.84–1.36; p = .57). Conclusion: In resuscitated SCA patients without ST-elevation who underwent coronary angiography, this large retrospective study found severe coronary artery stenosis in 43.9% but found no clear benefit of early PCI. Prospective randomized controlled trials are needed to accurately define the role of coronary angiography and PCI in post-resuscitation care.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Coronary angiography, PCI, Sudden cardiac arrest, Sudden cardiac arrest without STEMI, SWEDEHEART
in
Resuscitation
volume
126
pages
172 - 178
publisher
Elsevier
external identifiers
  • scopus:85044738102
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2018.01.044
language
English
LU publication?
yes
id
edd46681-45f6-4ecf-ae8f-fe109418edd7
date added to LUP
2018-04-12 14:17:28
date last changed
2019-01-27 05:27:18
@article{edd46681-45f6-4ecf-ae8f-fe109418edd7,
  abstract     = {<p>Background/aim: Sudden cardiac arrest (SCA) has a substantial mortality rate and the acute coronary syndrome constitutes the major cause. Post-resuscitation electrocardiogram ST-elevation SCA (STE-SCA) is a strong indication for emergency coronary angiography, but the role of early angiography and PCI in patients without ST-elevation (NSTE-SCA) remains to be established. This paper aimed to describe this patient group and evaluate the prognostic effect of early PCI in a large nationwide cohort of NSTE-SCA patients undergoing coronary angiography. Methods: Data from SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) on 4308 SCA patients in Sweden between 2005 and 2016 were descriptively analyzed and related to mortality within 30-days in both unadjusted and adjusted analyses using Cox proportional hazard models. Results: NSTE-SCA patients had more often serious comorbidities than STE-SCA patients. Among NSTE-SCA patients, 36.4% had no significant coronary artery stenosis while severe coronary stenosis (≥90%) was present in 43.9% (1271/2896). In NSTE-SCA patients with significant stenosis (≥90%), PCI was performed in 59.2% (753/1271) with an increased unadjusted 30-day mortality (40.9% vs. 32.7%; p = .011). However, after adjustments for confounders, no difference in mortality was observed (hazard ratio 1.07; 95% CI 0.84–1.36; p = .57). Conclusion: In resuscitated SCA patients without ST-elevation who underwent coronary angiography, this large retrospective study found severe coronary artery stenosis in 43.9% but found no clear benefit of early PCI. Prospective randomized controlled trials are needed to accurately define the role of coronary angiography and PCI in post-resuscitation care.</p>},
  author       = {Wester, Axel and Mohammad, Moman A. and Andell, Pontus and Rylance, Rebecca and Dankiewicz, Josef and Friberg, Hans and James, Stefan and Omerovic, Elmir and Erlinge, David and Koul, Sasha},
  issn         = {0300-9572},
  keyword      = {Coronary angiography,PCI,Sudden cardiac arrest,Sudden cardiac arrest without STEMI,SWEDEHEART},
  language     = {eng},
  month        = {02},
  pages        = {172--178},
  publisher    = {Elsevier},
  series       = {Resuscitation},
  title        = {Coronary angiographic findings and outcomes in patients with sudden cardiac arrest without ST-elevation myocardial infarction : A SWEDEHEART study},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2018.01.044},
  volume       = {126},
  year         = {2018},
}