SPC365

Coronary angiography after out-of-hospital cardiac arrest without ST-segment elevation: is it time to cool down?

Session: Posters (Sessão 6 - Écran 6) - Síndromes Coronárias Agudas e Crónicas
Speaker: André Filipe Macedo Alexandre

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 12. Coronary Artery Disease (Chronic)
Subtheme: 12.8 Coronary Artery Disease - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: André Alexandre; Bruno Brochado; André Dias-Frias; Andreia Campinas; David Sá-Couto; Anaisa Pereira; Mariana Santos; Maria Trêpa; Raquel Santos; André Luz; João Silveira; Severo Torres

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Ischaemic heart disease is a major cause of out-of-hospital cardiac arrest (OHCA). In resuscitated OHCA patients without ST-segment elevation, the role of emergent coronary angiography (CA) remains uncertain. Recent guidelines recommend a non-emergent CA strategy in this subgroup of patients.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Aim</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: To determine whether emergent CA has a positive impact on clinical outcomes in patients with OHCA, without ST-segment elevation, when compared to non-emergent CA.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">This is a retrospective study of OHCA patients</span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">, without ST-elevation, undergoing coronary angiography</span></span> <span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">in a PCI centre between Jan 2010 to Dec 2021. From a general cohort of &gt; 9.000 patients admitted to cardiac catheterisation, we obtained a population of 28 patients who fulfilled the inclusion criteria. Emergent CA was defined as CA performed in less than 2 hours. The patients were also classified as &ldquo;ischaemic&rdquo; versus &ldquo;non-ischaemic&rdquo; according to the aetiology of OHCA. The </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">primary endpoint was &ldquo;24-hour mortality&rdquo;.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: 28 OHCA patients </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">without ST-elevation were included. </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">The mean age was 60.8 (&plusmn;15.1) years and 64% were male. 71% patients performed emergent CA and only 29% underwent a non-emergent strategy. There were no statistically significant differences regarding baseline characteristics and outcomes between emergent vs non-emergent CA groups. On the other hand, only 64% of patients were classified as &ldquo;ischaemic&rdquo;. In the remaining 36%, the aetiology was primary cardiac arrhythmia (50%), intracranial haemorrhage (10%), or unknown cause (40%). Regarding baseline characteristics, patients from the &ldquo;ischaemic&rdquo; group were older (65.2 vs 52.9 years, p=0.035) and more likely to have hypertension (72% vs 30%, p=0.046) or previous coronary artery disease (50% vs 10%, p=0.042). No statistically significant differences were found regarding outcomes between ischaemic versus non-ischaemic groups. Kaplan-Meier analyses showed no differences in 12-month </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">mortality between </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">&ldquo;emergent CA&rdquo; versus &ldquo;non-emergent CA&rdquo; and &ldquo;ischaemic&rdquo; versus &ldquo;non-ischaemic&rdquo; groups (p=0.850 and p=0.792, respectively).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Our real-world study suggests that, in accordance with </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">contemporary randomised trials, emergent CA in resuscitated OHCA patients without ST-elevation has unclear benefits when compared with a non-emergent invasive strategy.</span></span></span></span></p>