The following is a summary of “Acute Coronary Occlusion in Patients With Non-ST-Segment Elevation Out-of-Hospital Cardiac Arrest,” published in the February 2023 issue of Cardiology by Spirito, et al.

Current recommendations state that in out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation, hemodynamic status should determine whether urgent or delayed coronary angiography (CAG) is performed. A delayed strategy is advocated in patients with hemodynamic stability, whereas an urgent strategy is advisedin patients with hemodynamic instability, an urgent strategy is advised. In patients with hemodynamically stable and unstable OHCA who did not have ST-segment elevation, researchers sought to evaluate the prevalence, predictors, and clinical effects of acute coronary occlusion.

Included were consecutive unresponsive OHCA patients without ST-segment elevation who underwent CAG at Bern University Hospital (Bern, Switzerland) between 2011 and 2019. Assessments were made of the prevalence, predictors, and effects of acute coronary artery occlusions on cardiovascular and all-cause mortality at one year.

About 169 (43.8%) of the 386 patients had stable hemodynamics. Initial chest pain and a shockable rhythm, but not a hemodynamic state, were predictive of the existence of acute coronary occlusions, which were observed in 19.5% of stable and 24.0% of unstable OHCA patients (P = 0.407). Acute coronary occlusion was not linked to an increased risk of death from any cause (adjusted HR: 0.72; 95% CI: 0.44-1.18), but it was linked to an increased risk of death from cardiovascular causes (adjusted HR: 2.74; 95% CI: 1.22-6.15). There was no correlation between hemodynamic instability and catastrophic consequences.

Among OHCA patients without ST-segment elevation, 1 in 5 had acute coronary artery occlusions. Patients who were stable or unstable had the same incidence of these occlusions, and the occlusions were linked to an increased risk of cardiovascular mortality. Chest discomfort or a shockable rhythm, as opposed to a hemodynamic state, helped to identify individuals with acute coronary occlusion in OHCA patients without ST-segment elevation.

Reference: jacc.org/doi/10.1016/j.jacc.2022.10.039