Outcomes of Comatose Cardiac Arrest Survivors With and Without ST-Segment€Elevation Myocardial€Infarction

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 thosewithout 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 198with 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 1⁄4 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%; p1⁄4 0.60). A culprit vessel was more frequently identified in those with STEMI, but also in one-third of patientswithout STEMI (80.2% vs. 33.2%; p1⁄40.001). Themajority 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 associatedwith improved functional outcome among resuscitated patients with andwithout STEMI. Resuscitated patientswith a presumed cardiac etiology appear to benefit from immediate coronary angiography. (J Am Coll Cardiol Intv 2015;8:1031–40) © 2015 by the American College of Cardiology Foundation. SEE PAGE 1041 C ardiac arrest remains a major public health issue in the United States. After decades of dismal overall national survival rates of only 5% to 7% (1), progress is finally been realized. Several new and innovative systematic approaches to resuscitation, such as cardiocerebral resuscitation with chest compression–only cardiopulmonary resuscitation (2) and Take Heart America (3) have led the way to improving long-term survival. The next important step for further improving survival of cardiac arrest is post-resuscitation care. Aggressive post–cardiac arrest care, including targeted temperature management (TTM) and coronary artery reperfusion, can double the number of outof-hospital cardiac arrest patients surviving to hospital discharge (4,5). French investigators showed that 70% of those resuscitated from out-of-hospital cardiac arrest and taken immediately to coronary angiography (CAG) have coronary artery disease. They found that nearly 50% of such resuscitated patients have an acutely occluded coronary vessel (6). The assumption is that such an acute coronary occlusion was the likely trigger of the cardiac arrest. If the majority of adult out-of-hospital cardiac arrests are precipitated by an acute ischemic event, particularly an acute coronary occlusion, then the strategy of immediate coronary angiography with potential percutaneous coronary intervention (PCI) seems appropriate. Timely reperfusion of acute coronary occlusions in nonarrested patients has been proved to improve both left ventricular function and survival. When an acutely occluded coronary vessel is responsible for triggering cardiac arrest, systemic circulation must be restored by cardiopulmonary resuscitation and defibrillation, followed by timely reperfusion of the culprit coronary vessel to prevent rearrest or hemodynamic collapse and to preserve myocardial function. Recently, both the European Society of Cardiology and the American College of Cardiology Foundation AB BR E V I A T I O N S