PMID- 36997434 OWN - NLM STAT- MEDLINE DCOM- 20230425 LR - 20230428 IS - 0736-4679 (Print) IS - 0736-4679 (Linking) VI - 64 IP - 4 DP - 2023 Apr TI - Timing and Outcomes After Coronary Angiography Following Out-of-Hospital Cardiac Arrest Without Signs of ST-Segment Elevation Myocardial Infarction. PG - 439-447 LID - S0736-4679(23)00007-0 [pii] LID - 10.1016/j.jemermed.2023.01.006 [doi] AB - BACKGROUND: There is broad consensus that resuscitated out-of-hospital cardiac arrest (OHCA) patients with ST-segment elevation myocardial infarction (STEMI) should receive immediate coronary angiography (CAG); however, factors that guide patient selection and optimal timing of CAG for post-arrest patients without evidence of STEMI remain incompletely described. OBJECTIVE: We sought to describe the timing of post-arrest CAG in actual practice, patient characteristics associated with decision to perform immediate vs. delayed CAG, and patient outcomes after CAG. METHODS: We conducted a retrospective cohort study at seven U.S. academic hospitals. Resuscitated adult patients with OHCA were included if they presented between January 1, 2015 and December 31, 2019 and received CAG during hospitalization. Emergency medical services run sheets and hospital records were analyzed. Patients without evidence of STEMI were grouped and compared based on time from arrival to CAG performance into "early" ( 6 h). RESULTS: Two hundred twenty-one patients were included. Median time to CAG was 18.6 h (interquartile range [IQR] 1.5-94.6 h). Early catheterization was performed on 94 patients (42.5%) and delayed catheterization was performed on 127 patients (57.5%). Patients in the early group were older (61 years [IQR 55-70 years] vs. 57 years [IQR 47-65] years) and more likely to be male (79.8% vs. 59.8%). Those in the early group were more likely to have clinically significant lesions (58.5% vs. 39.4%) and receive revascularization (41.5% vs. 19.7%). Patients were more likely to die in the early group (47.9% vs. 33.1%). Among survivors, there was no significant difference in neurologic recovery at discharge. CONCLUSIONS: OHCA patients without evidence of STEMI who received early CAG were older and more likely to be male. This group was more likely to have intervenable lesions and receive revascularization. CI - Copyright (c) 2023 Elsevier Inc. All rights reserved. FAU - Helber, Andrew R AU - Helber AR AD - Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Helfer, David R AU - Helfer DR AD - Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Ferko, Aarika R AU - Ferko AR AD - Department of Emergency Medicine, Reading Hospital, Reading, Pennsylvania. FAU - Klein, Daniel D AU - Klein DD AD - Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania. FAU - Elchediak, Daniel AU - Elchediak D AD - Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania. FAU - Deaner, Traci S AU - Deaner TS AD - Department of Emergency Medicine, Reading Hospital, Reading, Pennsylvania. FAU - Slagle, Dustin AU - Slagle D AD - Department of Emergency Medicine, ChristianaCare, Newark, Delaware. FAU - White, William B AU - White WB AD - Department of Pulmonary and Critical Care, Maine Medical Center, Portland, Maine. FAU - Buckler, David G AU - Buckler DG AD - Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Mitchell, Oscar J L AU - Mitchell OJL AD - Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Fiorilli, Paul N AU - Fiorilli PN AD - Department of Medicine, Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Isenberg, Derek L AU - Isenberg DL AD - Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania. FAU - Nomura, Jason T AU - Nomura JT AD - Department of Emergency Medicine, ChristianaCare, Newark, Delaware. FAU - Murphy, Kathleen A AU - Murphy KA AD - Department of Emergency Medicine, ChristianaCare, Newark, Delaware. FAU - Sigal, Adam AU - Sigal A AD - Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Emergency Medicine, Reading Hospital, Reading, Pennsylvania. FAU - Saif, Hassam AU - Saif H AD - Lehigh Valley Heart and Vascular Institute, Allentown, Pennsylvania. FAU - Reihart, Michael J AU - Reihart MJ AD - Department of Emergency Services, Penn State Health, Lancaster Medical Center, Lancaster, Pennsylvania. FAU - Vernon, Tawnya M AU - Vernon TM AD - Penn Medicine Lancaster General Hospital, Lancaster, Pennsylvania. FAU - Abella, Benjamin S AU - Abella BS AD - Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230328 PL - United States TA - J Emerg Med JT - The Journal of emergency medicine JID - 8412174 SB - IM MH - Adult MH - Humans MH - Male MH - Female MH - Coronary Angiography MH - *Out-of-Hospital Cardiac Arrest/complications MH - *ST Elevation Myocardial Infarction/complications MH - Retrospective Studies MH - *Cardiopulmonary Resuscitation MH - Registries MH - *Percutaneous Coronary Intervention OTO - NOTNLM OT - cardiac arrest OT - coronary angiography OT - coronary artery disease OT - resuscitation EDAT- 2023/03/31 06:00 MHDA- 2023/04/25 06:42 CRDT- 2023/03/30 22:06 PHST- 2022/09/06 00:00 [received] PHST- 2022/12/15 00:00 [revised] PHST- 2023/01/06 00:00 [accepted] PHST- 2023/04/25 06:42 [medline] PHST- 2023/03/31 06:00 [pubmed] PHST- 2023/03/30 22:06 [entrez] AID - S0736-4679(23)00007-0 [pii] AID - 10.1016/j.jemermed.2023.01.006 [doi] PST - ppublish SO - J Emerg Med. 2023 Apr;64(4):439-447. doi: 10.1016/j.jemermed.2023.01.006. Epub 2023 Mar 28.