• David R Helfer, Andrew R Helber, Aarika R Ferko, Daniel D Klein, Daniel S Elchediak, Traci S Deaner, Dustin Slagle, William B White, David G Buckler, MitchellOscar J LOJLDepartment of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA.Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pennsylvan, Paul N Fiorilli, Derek Isenberg, Jason Nomura, Kathleen A Murphy, Adam Sigal, Hassam Saif, Michael J Reihart, Tawnya M Vernon, and Benjamin S Abella.
• Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
• Acad Emerg Med. 2022 Apr 1; 29 (4): 456-464.

ObjectivesOut-of-hospital cardiac arrest (OHCA) afflicts >350,000 people annually in the United States. While postarrest coronary angiography (CAG) with percutaneous coronary intervention (PCI) has been associated with improved survival in observational cohorts, substantial uncertainty exists regarding patient selection for postarrest CAG. We tested the hypothesis that symptoms consistent with acute coronary syndrome (ACS), including chest discomfort, prior to OHCAs are associated with significant coronary lesions identified on postarrest CAG.MethodsWe conducted a multicenter retrospective cohort study among eight regional hospitals. Adult patients who experienced atraumatic OHCA with successful initial resuscitation and subsequent CAG between January 2015 and December 2019 were included. We collected data on prehospital documentation of potential ACS symptoms prior to OHCA as well as clinical factors readily available during postarrest care. The primary outcome in multivariable regression modeling was the presence of significant coronary lesions (defined as >50% stenosis of left main or >75% stenosis of other coronary arteries).ResultsFour-hundred patients were included. Median (interquartile range) age was 59 (51-69) years; 31% were female. At least one significant stenosis was found in 62%, of whom 71% received PCI. Clinical factors independently associated with a significant lesion included a history of myocardial infarction (adjusted odds ratio [aOR] = 6.5, [95% confidence interval {CI} = 1.3 to 32.4], p = 0.02), prearrest chest discomfort (aOR = 4.8 [95% CI = 2.1 to 11.8], p ≤ 0.001), ST-segment elevations (aOR = 3.2 [95% CI = 1.7 to 6.3], p < 0.001), and an initial shockable rhythm (aOR = 1.9 [95% CI = 1.0 to 3.4], p = 0.05).ConclusionsAmong survivors of OHCA receiving CAG, history of prearrest chest discomfort was significantly and independently associated with significant coronary artery lesions on postarrest CAG. This suggests that we may be able to use prearrest symptoms to better risk stratify patients following OHCA to decide who will benefit from invasive angiography.© 2021 Society for Academic Emergency Medicine.

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