SPC365

A single center study of patients who suffered cardiac arrest with a presumed diagnosis of acute coronary syndrome

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: MARIANA GOMES TINOCO

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.6 Acute Coronary Syndromes - Clinical
Session Type: Posters
FP Number: ---
Authors: Mariana Tinoco; Pedro Von Hafe; Geraldo Dias; Filipa Cardoso; Tamara Pereira; Rogerio Corga da Silva; Sergio Leite; António Lourenço

<p><span style="font-size:12pt"><span style="background-color:white"><strong><span style="color:black">Introduction:&nbsp;</span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">Patients with cardiac arrest (CA) have less than 20% of survival. Although a majority of deaths due to CA occur during the initial res</span><span style="color:black">uscitation, a substantial proportion of CA deaths occur in patients who have been successfully resuscitated. In CA patients with suspected acute coronary syndrome (ACS), early coronary angiography (ECA) with </span><span style="color:black">percutaneous coronary intervention&nbsp;(</span><span style="color:black">PCI) has been associated with improved survival.&nbsp; </span></span></span></p>

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<p><span style="font-size:12pt"><span style="background-color:white"><strong><span style="color:black">Objectives:&nbsp;</span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">To characterize a population who suffered CA with a presumed diagnosis of acute coronary syndrome (ACS).&nbsp;</span></span></span></p>

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<p><span style="font-size:12pt"><span style="background-color:white"><strong><span style="color:black">Methods:&nbsp;</span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">Retrospective, single center study of 37 patients who suffered CA with&nbsp;a presumed diagnosis of ACS, between 2017 and 2020.</span></span></span></p>

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<p><span style="font-size:12pt"><span style="background-color:white"><strong><span style="color:black">Results:</span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">A total of 37 patients with out-of-hospital CA and in-hospital CA were included. The population&#39;s&nbsp;mean age&nbsp;was 68 years and 70% were male.&nbsp;Thirty-one (83%) patients presented with chest pain suggestive of ischemic etiology. The first ECG showed ST segment elevation in 12 (32,5%), ST segment depression in 12 (32,5%), &ldquo;de novo&rdquo;&nbsp;left bundle branch block (LBBB) in 5 (13,5%), LBBB known previously in 3 (8%), nonspecific&nbsp;repolarization changes and pathologic&nbsp;T wave inversion in 5 (13,5%).</span></span></span></p>

<p><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">Re-establishment of spontaneous circulation (ROSC) was possible in 13 (37%) patients (of whom only 3 (23%) had a non-shockable rhythm). Of these, 8 (62%) were transferred to a PCI center. The remaining 5 (38%) were considered not candidates to early coronary angiography (ECA) due to comorbidities. Six (75%) patients who were transferred were&nbsp;submitted to&nbsp;an ECA and&nbsp;all had PCI. </span></span></span></p>

<p><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">At 30 days, 8 (62%) patients in whom ROSC was possible were alive. Of these, 6 (75%) had PCI. </span></span></span></p>

<p><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">Patient selection for ECA favored male patients (83%), age under 75 (mean age 56), patients with a shockable rhythm in CA and an ECG with ST elevation on the post-ROSC ECG.</span></span></span></p>

<p><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">Among the 24 (65%) patients who died, in 15 (62.5%) the rhythm was non-shockable.</span></span></span></p>

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<p><span style="font-size:12pt"><span style="background-color:white"><strong><span style="color:black">Conclusion:</span></strong></span></span></p>

<ol>
	<li><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">The majority of deaths due to CA of ischemic etiology occur during initial resuscitation. However, more than half of those who survive are alive at 30 days. </span></span></span></li>
	<li><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">In patients with CA due to suspected ACS, the presence of shockable rhythm and early coronary angiography with PCI appears to be associated with a clear better outcome.</span></span></span></li>
	<li><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">With the limitations of the currently published literature and heterogeneity of patients presenting with CA and ACS, selecting appropriate patients for early coronary angiography remains a challenging decision.</span></span></span></li>
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