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Impact of Coronary Lesion Stability on the Benefit of Emergent PCI After Sudden Cardiac Arrest
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Conflicting data exist regarding the benefit of urgent coronary angiogram and percutaneous coronary intervention (PCI) after sudden cardiac arrest, particularly in the absence of ST-segment elevation. We hypothesized that the type of lesions treated (stable versus unstable) influences the benefit derived from PCI.
METHODS
Data were taken between May 2011 and 2014 from a prospective registry enrolling all sudden cardiac arrest in Paris and suburbs (6.7 million inhabitants). Patients undergoing emergent coronary angiogram were included. Decision to perform PCI was left to the discretion of local teams. We assessed the impact of emergent PCI on survival at discharge according to whether the treated lesion was angiographically unstable or stable, and we investigated the predictive factors for unstable coronary lesions.
RESULTS
Among 9265 sudden cardiac arrests occurring during the study period, 1078 underwent emergent coronary angiogram (median age: 59.6 years, 78.3% males): 463 (42.9%) had an unstable lesion, 253 (23.5%) only stable lesions, and 362 (33.6%) no significant lesions. Emergent PCI was performed in 478 patients (91.4% of unstable and 21.7% of stable lesions). At discharge, PCI of unstable lesions was associated with twice-higher survival rate compared with untreated unstable lesions (47.9% versus 25.6%, P=0.013), while stable lesions PCI did not improve survival (25.5% versus 26.3%, P=1.00). After adjustment, PCI of unstable coronary lesions was independently associated with improved survival (odds ratio, 2.09 [95% CI, 1.42-3.09], P<0.001), contrary to PCI of stable lesions (odds ratio, 0.92 [95% CI. 0.44-1.87], P=0.824). Angina, initial shockable rhythm, ST-segment elevation, and absence of known coronary artery disease were independent predictors of unstable lesions.
CONCLUSIONS
Emergent PCI of unstable lesions is associated with improved survival after sudden cardiac arrest, contrary to PCI of stable lesions. Accordingly, early PCI should only be performed in patients with unstable lesions. Four factors (chest pain, ST-elevation, absence of coronary artery disease history, and shockable initial rhythm) could help identify patients with unstable lesions who would, therefore, benefit from emergent coronary angiogram.
Additional Info
Impact of Coronary Lesion Stability on the Benefit of Emergent Percutaneous Coronary Intervention After Sudden Cardiac Arrest
Circ Cardiovasc Interv 2020 Sep 08;[EPub Ahead of Print], L Pechmajou, E Marijon, O Varenne, F Dumas, F Beganton, D Jost, L Lamhaut, E Lecarpentier, T Loeb, JM Agostinucci, G Sideris, E Riant, P Baudinaud, A Hagege, W Bougouin, C Spaulding, A Cariou, X Jouven, N KaramFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Out-of-hospital cardiac arrest is a challenging dilemma for the interventional cardiologist and emergency department physicians as these patients have high mortality. In this study, the authors highlight the importance of bringing these patients to the cath lab for coronary angiography. It’s worth noting that, in this study, almost two-thirds of the patients had witnessed arrest and received CPR, which speaks to the public awareness and education for on-site cardiac arrest resuscitation. In this study, almost 12% of the patients who presented with sudden cardiac arrest underwent emergent coronary angiography, of whom 43% had unstable lesions. Patients who underwent PCI for unstable lesions had higher survival rates compared with those who had stable lesions.
Based on the findings of the current study, it is beneficial and associated with better survival to bring out-of-hospital cardiac arrest patients who present with chest pain, ST-elevation on EKG, and shakable initial rhythm to the cath lab for coronary angiography. Although PCI for unstable lesions was associated with higher survival, PCI for stable lesions was not associated with better survival, and therefore routine PCI for these patients is not recommended.