Post-arrest culprit lesions with no STEMI on ECG

Short Attention Span Summary

Post-arrest cath
STEMI on ECG after arrest warrants a trip to the cath lab, but those without STEMI criteria are less clear.  This systematic review found that ⅓ of patients without post-arrest STEMI who were taken for cardiac cath had culprit lesions requiring intervention (vs. >70% of those with STEMI on post-arrest ECG).

Spoon Feed
One third of patients would benefit from post-arrest cath even if they lack STEMI criteria on ECG.  Our job is to involve cardiology and let them make the call on who goes to the cath lab.


Abstract

Resuscitation. 2016 Sep 15;108:54-60. doi: 10.1016/j.resuscitation.2016.09.004. [Epub ahead of print]

Patients without ST elevation after return of spontaneous circulation may benefit from emergent percutaneous intervention: A systematic review and meta-analysis.

Millin MG1, Comer AC2, Nable JV3, Johnston PV4, Lawner BJ5, Woltman N6, Levy MJ7, Seaman KG8, Hirshon JM9.

Author information: 

  • 1Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: millin@jhmi.edu.
  • 2National Study Center for the Study of Trauma and EMS Baltimore, MD, United States. Electronic address: acomer@stapa.umm.edu.
  • 3MedStar Georgetown University Hospital, United States. Electronic address: JVNable@gmail.com.
  • 4Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: pjohnst1@jhmi.edu.
  • 5University of Maryland School of Medicine Baltimore, MD, United States. Electronic address: blawn001@umaryland.edu.
  • 6Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: nwoltma1@jhmi.edu.
  • 7Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: levy@jhmi.edu.
  • 8Maryland Institute for Emergency Medical Services Systems, Baltimore, MD, United States. Electronic address: kseaman@miemss.org.
  • 9University of Maryland School of Medicine Baltimore, MD, United States. Electronic address: jhirshon@umaryland.edu.

ABSTRACT

INTRODUCTION: 

The American Heart Association recommends that post-arrest patients with evidence of ST elevation myocardial infarction (STEMI) on electrocardiogram (ECG) be emergently taken to the catheterization lab for percutaneous coronary intervention (PCI). However, recommendations regarding the utility of emergent PCI for patients without ST elevation are less specific. This review examined the literature on the utility of PCI in post-arrest patients without ST elevation compared to patients with STEMI.

METHODS: 

A systematic review of the English language literature was performed for all years to March 1, 2015 to examine the hypothesis that a percentage of post-cardiac arrest patients without ST elevation will benefit from emergent PCI as defined by evidence of an acute culprit coronary lesion.

RESULTS: 

Out of 1067 articles reviewed, 11 articles were identified that allowed for analysis of data to examine our study hypothesis. These studies show that patients presenting post cardiac arrest with STEMI are thirteen times more likely to be emergently taken to the catheterization lab than patients without STEMI; OR 13.8 (95% CI 4.9-39.0). Most importantly, the cumulative data show that when taken to the catheterization lab as much as 32.2% of patients without ST elevation had an acute culprit lesion requiring intervention, compared to 71.9% of patients with STEMI; OR 0.15 (95% CI 0.06-0.34).

CONCLUSION: 

The results of this systematic review demonstrate that nearly one third of patients who have been successfully resuscitated from cardiopulmonary arrest without ST elevation on ECG have an acute lesion that would benefit from emergent percutaneous coronary intervention.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved

PMID: 27640933 [PubMed - as supplied by publisher]

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