IMMEDIATE CORONARY ANGIOGRAPHY IN SURVIVORS OF OUT-OF-HOSPITAL CARDIAC-ARREST

Background The incidence of acute coronary-artery occlusion among pati ents with sudden cardiac arrest outside of the hospital is unknown, an d the role of reperfusion therapy has not been determined. We therefor e performed immediate coronary angiography and angioplasty when indica ted in survivors of out-of-hospital cardiac arrest. Methods Between Se ptember 1994 and August 1996, coronary angiography was performed in 84 consecutive patients between the ages of 30 and 75 years who had no o bvious noncardiac cause of cardiac arrest. Results Sixty of the 84 pat ients had clinically significant coronary disease on angiography, 40 o f whom had coronary-artery occlusion (48 percent). Angioplasty was att empted in 37 patients and was technically successful in 28. Clinical a nd electrocardiographic findings, such as the occurrence of chest pain and the presence of ST-segment elevation, were poor predictors of acu te coronary-artery occlusion. The in-hospital survival rate was 38 per cent. Multivariate logistic-regression analysis revealed that successf ul angioplasty was an independent predictor of survival (odds ratio, 5 .2; 95 percent confidence interval, 1.1 to 24.5; P=0.04). Conclusions Acute coronary-artery occlusion is frequent in survivors of out-of-hos pital cardiac arrest and is predicted poorly by clinical and electroca rdiographic findings. Accurate diagnosis by immediate coronary angiogr aphy can be followed in suitable candidates by coronary angioplasty, w hich seems to improve survival. (C) 1997, Massachusetts Medical Societ y.