• Henrik Stær-Jensen, Espen Rostrup Nakstad, Eigil Fossum, Arild Mangschau, Jan Eritsland, Tomas Drægni, Dag Jacobsen, Kjetil Sunde, and Geir Øystein Andersen.
• From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway. uxshph@ous-hf.no.
• Circ Cardiovasc Interv. 2015 Oct 1; 8 (10).

BackgroundWe aimed to investigate coronary angiographic findings in unselected out-of-hospital cardiac arrest patients referred to immediate coronary angiography (ICA) irrespective of their first postresuscitation ECG and to determine whether this ECG is useful to select patients with no need of ICA.Methods And ResultsAll resuscitated patients admitted after out-of-hospital cardiac arrest without a clear noncardiac cause underwent ICA. Patients were retrospectively grouped according to the postresuscitation ECG blinded for ICA results: (1) ST elevation or presumably new left bundle branch block, (2) other ECG signs indicating myocardial ischemia, and (3) no ECG signs indicating myocardial ischemia. All coronary angiograms were reevaluated blinded for postresuscitation ECGs. Two hundred and ten patients were included with mean age 62±12 years. Six-months survival with good neurological outcome was 54%. Reduced Thrombolysis in Myocardial Infarction flow (0-2) was found in 55%, 34%, and 18% and a ≥90% coronary stenosis was present in 25%, 27%, and 19% of patients in group 1, 2, and 3, respectively. An acute coronary occlusion was found in 11% of patients in group 3. ST elevation/left bundle branch block identified patients with reduced Thrombolysis in Myocardial Infarction (0-2) flow with 70% sensitivity and 62% specificity. Among patients with initial nonshockable rhythms (24%), 32% had significantly reduced Thrombolysis in Myocardial Infarction flow.ConclusionsInitial ECG findings are not reliable in detecting patients with an indication for ICA after experiencing a cardiac arrest. Even in the absence of ECG changes indicating myocardial ischemia, an acute culprit lesion may be present and patients may benefit from emergent revascularization. CLINICAL TRIAL REGISTRATIONURL: http://www.clinicaltrials.gov. Unique identifier: NCT01239420.© 2015 American Heart Association, Inc.

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