{"title":"Out-of-Hospital Cardiac Arrest Survivors Without ST-Segment Elevation had Lower Coronary Artery Stenosis in an Asian Population.","authors":"Yaw-Ren Hsu, Chien-Hua Huang, Han-Lin Yao, Yi-Wen Wu, Wei-Ting Chen, Wen-Jone Chen, Wei-Tien Chang, Min-Shan Tsai","doi":"10.1016/j.acepjo.2024.100036","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Guidelines recommend emergent coronary angiography (CAG) for out-of-hospital cardiac arrest (OHCA) patients with ST-segment elevation (STE) and selective angiography for those without STE. However, real-world data reporting coronary artery status in OHCA patients without STE are scarce, especially in an Asian population. This study evaluated the coronary artery status and associated outcomes in Asian OHCA patients without STE, comparing the results with those of patients with STE.</p><p><strong>Methods: </strong>This retrospective study enrolled 345 OHCA survivors with presumed cardiogenic cause who underwent CAG. Based on electrocardiographic evidence of STE following return of spontaneous circulation, the patients were segmented into an STE group (<i>n</i> = 150) and a non-STE group (<i>n</i> = 195). The CAG findings and percutaneous intervention details for the non-STE group were compared with those of the STE group. Chi-squared tests were applied for categorical variables, whereas Mann-Whitney U tests were applied for continuous variables.</p><p><strong>Results: </strong>Compared with the STE group, the non-STE group had a lower but still high prevalence of coronary artery stenosis (69.7% vs 91.3%, <i>P</i> < .001) and multivessel involvement (50.8% vs 68.0%, <i>P</i> = .001), especially in the left anterior descending coronary artery (56.9% vs 79.3%, <i>P</i> < .001). No differences in survival-to-discharge and neurological outcomes were observed.</p><p><strong>Conclusion: </strong>In OHCA survivors with presumed acute coronary syndrome, there was a high prevalence of coronary artery stenosis and multivessel involvement in patients without STE. Moreover, patients without STE had comparable survival-to-discharge and neurological outcomes with patients with STE.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100036"},"PeriodicalIF":1.6000,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852693/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American College of Emergency Physicians open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.acepjo.2024.100036","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Guidelines recommend emergent coronary angiography (CAG) for out-of-hospital cardiac arrest (OHCA) patients with ST-segment elevation (STE) and selective angiography for those without STE. However, real-world data reporting coronary artery status in OHCA patients without STE are scarce, especially in an Asian population. This study evaluated the coronary artery status and associated outcomes in Asian OHCA patients without STE, comparing the results with those of patients with STE.
Methods: This retrospective study enrolled 345 OHCA survivors with presumed cardiogenic cause who underwent CAG. Based on electrocardiographic evidence of STE following return of spontaneous circulation, the patients were segmented into an STE group (n = 150) and a non-STE group (n = 195). The CAG findings and percutaneous intervention details for the non-STE group were compared with those of the STE group. Chi-squared tests were applied for categorical variables, whereas Mann-Whitney U tests were applied for continuous variables.
Results: Compared with the STE group, the non-STE group had a lower but still high prevalence of coronary artery stenosis (69.7% vs 91.3%, P < .001) and multivessel involvement (50.8% vs 68.0%, P = .001), especially in the left anterior descending coronary artery (56.9% vs 79.3%, P < .001). No differences in survival-to-discharge and neurological outcomes were observed.
Conclusion: In OHCA survivors with presumed acute coronary syndrome, there was a high prevalence of coronary artery stenosis and multivessel involvement in patients without STE. Moreover, patients without STE had comparable survival-to-discharge and neurological outcomes with patients with STE.
目的:指南推荐急诊冠状动脉造影(CAG)用于院外心脏骤停(OHCA)患者st段抬高(STE)和选择性血管造影对那些没有STE的患者。然而,没有STE的OHCA患者的冠状动脉状况的真实数据很少,特别是在亚洲人群中。本研究评估了亚洲无STE的OHCA患者的冠状动脉状态和相关结果,并将结果与STE患者的结果进行了比较。方法:本回顾性研究纳入345例推定心源性原因的OHCA幸存者行CAG。根据自发循环恢复后STE的心电图证据,将患者分为STE组(n = 150)和非STE组(n = 195)。将非STE组的CAG表现和经皮介入治疗细节与STE组进行比较。分类变量采用卡方检验,连续变量采用Mann-Whitney U检验。结果:与STE组相比,非STE组冠状动脉狭窄(69.7% vs 91.3%, P < .001)和多支受累(50.8% vs 68.0%, P = .001)的发生率较低,但仍较高,尤其是左冠状动脉前降支(56.9% vs 79.3%, P < .001)。在存活至出院和神经预后方面没有观察到差异。结论:在推定为急性冠状动脉综合征的OHCA幸存者中,没有STE的患者冠状动脉狭窄和多支血管受累的发生率很高。此外,没有STE的患者与STE患者的生存-出院和神经预后相当。