Predictors of coronary artery disease in cardiac arrest survivors: coronary angiography for everyone? A single-center retrospective analysis.

Autor: Rigueira J; Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal., Aguiar-Ricardo I; Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal., Carrilho-Ferreira P; Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal., Menezes MN; Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal., Pereira S; Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal., Morais PS; Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal., Silva PCD; Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal., Pinto FJ; Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal.
Jazyk: Portuguese; English
Zdroj: Revista Brasileira de terapia intensiva [Rev Bras Ter Intensiva] 2021 Apr-Jun; Vol. 33 (2), pp. 251-260.
DOI: 10.5935/0103-507X.20210032
Abstrakt: 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.
Databáze: MEDLINE
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