Open AccessPredictors of coronary artery disease in cardiac arrest survivors: coronary angiography for everyone? A single-center retrospective analysis
Author(s) -
J Rigueira,
I Aguiar-Ricardo,
Pedro CarrilhoFerreira,
Miguel Nobre Menezes,
Sara Pereira,
Pedro Morais,
Pedro Canas da Silva,
Fausto J. Pinto
Publication year - 2021
Publication title -
revista brasileira de terapia intensiva
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.431
H-Index - 19
eISSN - 1982-4335
pISSN - 0103-507X
DOI - 10.5935/0103-507x.20210032
Subject(s) - medicine , cardiology , coronary artery disease , percutaneous coronary intervention , ejection fraction , retrospective cohort study , single center , myocardial infarction , heart failure
Objective To identify predictors of coronary artery disease in survivors of cardiac arrest, to define the best timing for coronary angiography and to establish the relationship between coronary artery disease and mortality. Methods This was a single-center retrospective study including consecutive patients who underwent coronary angiography after cardiac arrest. Results A total of 117 patients (63 ± 13 years, 77% men) were included. Most cardiac arrest incidents occurred with shockable rhythms (70.1%), and the median duration until the return of spontaneous circulation was 10 minutes. Significant coronary artery disease was found in 68.4% of patients, of whom 75% underwent percutaneous coronary intervention. ST-segment elevation (OR 6.5, 95%CI 2.2 - 19.6; p = 0.001), the presence of wall motion abnormalities (OR 22.0, 95%CI 5.7 - 84.6; p < 0.001), an left ventricular ejection fraction ≤ 40% (OR 6.2, 95%CI 1.8 - 21.8; p = 0.005) and elevated high sensitivity troponin T (OR 3.04, 95%CI 1.3 - 6.9; p = 0.008) were predictors of coronary artery disease; the latter had poor accuracy (area under the curve 0.64; p = 0.004), with an optimal cutoff of 170ng/L. Only ST-segment elevation and the presence of wall motion abnormalities were independent predictors of coronary artery disease. The duration of cardiac arrest (OR 1.015, 95%CI 1.0 - 1.05; p = 0.048) was an independent predictor of death, and shockable rhythm (OR 0.4, 95%CI 0.4 - 0.9; p = 0.031) was an independent predictor of survival. The presence of coronary artery disease and the performance of percutaneous coronary intervention had no impact on survival; it was not possible to establish the best cutoff for coronary angiography timing. Conclusion In patients with cardiac arrest, ST-segment elevation, wall motion abnormalities, left ventricular dysfunction and elevated high sensitivity troponin T were predictive of coronary artery disease. Neither coronary artery disease nor percutaneous coronary intervention significantly impacted survival.