Background
Emergent coronary angiography is recommended in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) of suspected cardiac origin. The aim of this study was to analyze the prevalence of chronic total occlusions in a cohort of consecutive patients resuscitated from OHCA due to a shockable rhythm, i.e. ventricular fibrillation (VF) and ventricular tachyardia (VT).
Methods
We analyzed the data of 150 consecutive patients in whom coronary angiography was performed in the setting of ROSC after OHCA. Patients with obstructive coronary artery disease (CAD) were classified as acute coronary syndrome (ST Elevation Myocardial Infarction (STEMI), Non ST Elevation Myocardial Infarction (NSTEMI)) or Chronic Coronary Syndrome. All angiograms were reviewed for the presence of chronic coronary occlusions. The culprit vessel was identified by means of electrocardiographic findings, echocardiography and coronary angiography.
Results
According to clinical und angiographic findings, an acute coronary syndrome was present in 105/150 patients (70%). Of the 105 patients with ACS, 53 (51%) presented with STEMI and 52 (49%) presented with NSTEMI. 18/150 patients (12%) showed a chronic coronary syndrome and obstructive coronary lesions were ruled out in 27/150 patients (18%).
41 (33%) of the 123 patients with obstructive coronary lesions (either CCS or ACS) showed a chronic total occlusion (CTO) of at least one vessel. 31 of them presented with ACS (14 with STEMI, 17 with NSTEM). 6 patients had history of coronary artery bypass graft surgery (CABG). CTO of 1 vessel was found in 34/41 patients (83%), CTO of 2 vessels in 6/41 patients (15%) und CTO of 3 vessels in 1 patient (2%). The most frequently affected vessel was the right coronary artery (55% of all CTOs), followed by the LAD (27%) and CX (18%). In 4/123 patients (3%), the chronic total occlusion was the only hemodynamically relevant angiographic lesion. In 29 patients (71%) with CTO, PCI of a non chronically occluded coronary artery was performed. TIMI flow after intervention was TIMI III in 96%, TIMI II in 4%.
Conclusion
Among patients resuscitated from OHCA due to VF/VT, the prevalence of coronary chronic total occlusions is high, with at least one CTO present in approximately one-third of all patients with underlying coronary artery disease . As in other clinical scenarios, this most frequently affects the RCA. Presence of a CTO may therefore be an independent risk factor associated with OHCA.
