Grant: Travel Awards - Institute Community Support

BACKGROUND: A cardiac arrest is characterized by sudden collapse of an individual, often requiring immediate or early defibrillation or CPR for resuscitation. Coronary heart disease, such as an acute heart attack, can often cause an out-of-hospital cardiac arrest. However, after an out-of-hospital cardiac arrest, in patients without an obvious sign of heart attack (ST elevation), we do not know whether an early coronary angiogram is beneficial. Thus, a coronary angiogram is not routinely performed and heavily debated. In this study, we examine the association between clinical characteristics and coronary heart disease in patients with an out-of-hospital cardiac arrest that received a coronary angiogram. METHODS: We performed an analysis of patients that suffered an out-of-hospital cardiac arrest in the Metro Vancouver area from 2009-2015, using the Resuscitation Outcomes Consortium Cardiac Arrest Registry. We reviewed electrocardiograms (ECG) for changes/signs of heart attack (ST elevation or ST depression). We reviewed coronary angiograms for coronary heart disease of significant severity, defined as obstructive or occlusive coronary artery disease. RESULTS: 604 patients suffered an out-of-hospital cardiac arrest during the study period. After statistical adjustment, the predictors of coronary heart disease included ECG changes consistent with heart attack (ST elevation). In patients without ST elevation, male sex, arrhythmia at presentation (VT/VF), and prior heart attack were associated with coronary heart disease. CONCLUSIONS: In patients without overt signs of heart attack, male sex, arrhythmia (VT/VF), and prior heart attack were the strongest predictors of coronary heart disease in patients that had suffered any out-of-hospital cardiac arrest. These results may help identify which patients, after an out-of-hospital cardiac arrest, may have significant coronary disease and may benefit from a coronary angiogram.