Post-resuscitation electrocardiograms, acute coronary findings and in-hospital prognosis of survivors of out-of-hospital cardiac arrest.

BACKGROUND: Identification of acute coronary lesions amenable to urgent intervention in survivors of out-of-hospital cardiac arrest is crucial. We aimed to compare the clinical and electrocardiographic characteristics to urgent coronary findings, and to analyze in-hospital prognosis of these patients.

METHODS: From January 2005 to December 2012 we retrospectively identified consecutive patients resuscitated from out-of-hospital cardiac arrest, and analyzed the clinical characteristics, post-resuscitation electrocardiogram and coronary angiogram of those who underwent emergent angiography. Mortality and neurologic status at discharge were also assessed.

RESULTS: Patients with ST-elevation more frequently had obstructive coronary artery disease (89% vs. 51%, p<0.001) or acute coronary occlusions (83% vs. 8%, p<0.001) than patients without ST-elevation. Independent predictors of an acute coronary occlusion were chest pain before arrest (OR 0.16, 95% CI 0.04-0.7, p=0.01), a shockable initial rhythm (OR 0.16, 95% CI 0.03-0.9, p=0.03), and ST-elevation on the post-resuscitation electrocardiogram (OR 0.02, 95% CI 0.004-0.13, p<0.001). Survival with favorable neurologic recovery at discharge was 59%. Independent predictors of mortality or unfavorable neurological outcome at discharge were absence of basic life support (OR 0.2, 95% CI 0.06-0.9, p=0.04), prolonged resuscitation time (OR 0.9, 95% CI 0.8-0.9, p=0.01), and necessity of vasopressors (OR 14.8, 95% CI 3.3-65.4, p=0.001).

CONCLUSIONS: Most patients with ST-elevation on the post-resuscitation electrocardiogram had an acute coronary occlusion, as opposed to patients without ST-elevation. Absence of basic life support, prolonged resuscitation time and use of vasopressors were independent predictors of worse in-hospital outcome.