Coronary angiography findings in cardiac arrest patients with non-diagnostic post-resuscitation electrocardiogram:A comparison of shockable and non-shockable initial rhythms

AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.METHODS From March 2004 to February 2016, 203 consecutive patients resuscitated from in or out-of-hospital sudden cardiac arrest and non-diagnostic post-resuscitation electrocardiogram(defined as ST segment elevation or pre-sumably new left bundle branch block) whounderwent invasive coronary angiogram during hospitalization were included. For purpose of analysis and comparison, patients were classified in two groups: Initial shockable rhythm(ventricular tachycardia or ventricular fibrillation; n = 148, 72.9%) and initial non-shockable rhythm(n = 55, 27.1%). Baseline characteristics, coronary angiogram findings including Syntax Score and long-term survival rates were compared. RESULTS Sudden cardiac arrest was witnessed in 95.2% of cases, 66.7% were out-of-hospital patients and 72.4% were male. There were no significant differences in baseline characteristics between groups except for higher mean age(68.1 years vs 61 years, P = 0.001) in the nonshockable rhythm group. Overall 5-year mortality of the resuscitated patients was 37.4%. Patients with non-shockable rhythms had higher mortality(60% vs 29.1%, P < 0.001) and a worst neurological status at hospital discharge based on cerebral performance category score(CPC 1-2: 32.7% vs 53.4%, P = 0.02). Although there were no significant differences in global burden of coronary artery disease defined by Syntax Score(mean Syntax Score: 10.2 vs 10.3, P = 0.96) there was a trend towards a higher incidence of acute coronary lesions in patients with shockable rhythm(29.7% vs 16.4%, P = 0.054). There was also a higher need for ad-hoc percutaneous coronary intervention in this group(21.9% vs 9.1%, P = 0.03). CONCLUSION Initial shockable group of patients had a trend towards higher incidence of acute coronary lesions and higher need of ad-hoc percutaneous intervention vs nonshockable group.

Is There Still a Place for Post-Resuscitation Electrocardiogram for Therapeutic Management and Coronary Angiogram Indication after Out-of-Hospital Cardiac Arrest?

Out-of-hospital cardiac arrest is a common cause of death. Some therapeutic strategies performed daily are still debated, including particularly emergency coronary angiography independently of the clinical pattern. Primary percutaneous coronary intervention seems the strategy of choice in ST-segment elevation myocardial infarction but in other clinical presentations, benefit of coronary angiogram remains controversial. To improve management of out-of-hospital cardiac arrest and define the best timing to perform coronary angiogram, we suggest a study design based on ECG evaluation to define predictors of coronary artery disease after resuscitated cardiac arrest by distinguishing 3 groups according to ECG after resuscitation: ST segment elevation and LBBB;repolarisation disorder or no repolarisation disorder. Evaluation of ECG changes may still be useful as a triage method for establishing the indication for emergency coronary angiogram due to easy, non invasive and quick method and thus for limiting complications associated with this exam in acute phase.

Successful extracorporeal life support in sudden cardiac arrest due to coronary anomaly

Extracorporeal life support(ECLS) has recently been reported to have a survival benefit in patients with cardiac arrest. It is now used widely as a lifesaving modality. Here, we describe a case of sudden cardiac arrest(SCA) in a young athlete with an anomalous origin of the right coronary artery from the left coronary sinus. Resuscitation was successful using ECLS before curative bypass surgery. We highlight the efficacy of ECLS for a patient with SCA caused by a rare, unexpected aetiology. In conclusion, ECLS was a lifesaving modality for SCA due to an anomalous coronary artery in this young patient.

Percutaneous Coronary Intervention Reduces Mortality in Out-of-Hospital Cardiac Arrest after Acute Coronary Syndrome: An Outcomes-Based Study from the Nationwide Inpatient Sample Database

Introduction: Mortality following cardiac arrest (CA) is extremely high, with rates as high as 91.5% after out-of-hospital cardiac arrest (OHCA) and 76.1% after in-hospital cardiac arrest (IHCA). This study assessed the clinical profile and outcomes of a large cohort of patients undergoing primary percutaneous coronary intervention (PCI) for OHCA to determine its effect on clinical outcomes and mortality. Methods: 247,456 patients with OHCA due to acute coronary syndrome (ACS) were abstracted from the Nationwide Inpatient Sample database (2001-2011). Results: Among 247,456 OHCA patients, 11,111 (4.5%) had PCI while 236,345 (95.5%) did not. Patients who underwent PCI were younger than those who did not receive PCI (64 vs. 66 years), p p p p 65 years, female gender, AA or Hispanic race, advanced cancer, and liver dysfunction as independent factors associated with increased mortality, while PCI conferred a survival advantage in OHCA, p Conclusion: Treatment with PCI was associated with a significant decrease in mortality. PCI was performed most often in Caucasians, males, patients > 50 years old, and those with Medicare. PCI significantly reduces mortality in OHCA patients and should be considered in all OHCA patients. Further investigation and development of methods to overcome the apparent socioeconomic barriers to PCI is required.

Selective Coronary Angiography Following Cardiac Arrest

Sudden cardiac arrest is a major cause of death predominantly caused by ventricular tachyarrhythmia in patients with coronary artery disease.Despite advancements in resuscitation care,the rate of survival after cardiac arrest remains low.There is a growing body of observational data suggesting early coronary angiography reduces delay to revascularization and may improve outcomes.Most survivors present comatose,and neurologic outcome is uncertain;therefore it is often challenging to identify patients who will benefit from early coronary angiography.Several variables and risk scores that predict a favorable neurologic outcome have been identified.The rationale and current evidence for early angiography are reviewed,and a suggested approach to the selection of patients is presented.

Coronary Perfusion Pressure Response to High-Dose Intraosseous versus Standard-Dose Intravenous Epinephrine Administration after Prolonged Cardiac Arrest

Background: This study was done to compare coronary perfusion pressure (CPP) prior to the first rescue shock (RS) among a group of animals that received intraosseous (IO) epinephrine 0.1 mg/ kg (high-dose epinephrine [HDE]) with a group that received intravenous (IV) epinephrine 0.01 mg/kg (standard-dose epinephrine [SDE]) during cardiac arrest resuscitation using a swine model of prolonged out-of-hospital ventricular fibrillation (VF) cardiac arrest. Methods: This was a secondary analysis of prospectively collected data from two IACUC approved protocols. Seventy-nine Yorkshire swine (25 - 35 kg) were surgically instrumented under anesthesia and VF was electrically induced. After 10 minutes of untreated VF in the IO study (n = 26) and 12 minutes of untreated VF in the IV study (n = 53), resuscitation commenced with closed chest compressions (CCC). A single dose of epinephrine (HDE IO or SDE IV, respectively) was given and flushed with saline. The CCC and RS attempts were standardized for all animals. The CPP was defined as aortic diastolic pressure minus right atrial diastolic pressure measured 2.5 minutes after medication delivery. Descriptive statistics were used to analyze the data. Results: Baseline group characteristics were mathematically the same. Just prior to the first RS, HDE IO resulted in a mean CPP of 33.2 mmHg (95%CI: 26.6, 39.9), while SDE IV resulted in a mean CPP of 25.0 mmHg (95%CI: 20.5, 29.4). Conclusion: This observation study reaffirms the assertion that HDE IO may be required to generate CPP values similar to SDE IV during resuscitation of prolonged VF.

Coronary Angiography in Patients with and without STEMI Following Out-of-Hospital Cardiac Arrest

Introduction: Little is known about discrepancies between patients who present with or without STEMI following out-of-hospital cardiac arrest (OHCA). Material and Methods: All patients with OHCA who were admitted to our hospital between January 1st 2008 and December 31st 2013 were classified according to their initial laboratory and electrocardiographic findings into STEMI, NSTEMI or no ACS. Results: Overall, 147 patients [32 STEMI (21.8%), 28 NSTEMI (19.0%) and 87 no ACS (59.2%)] were included with a mean age of 63.7 ± 13.3 years;there were 84 men (57.1%) and 63 (42.9%) women. Of these, 63 patients (51.7%) received coronary angiography [29 STEMI (90.6%), 9 NSTEMI (32.1%) and 38 no ACS (43.7%)] showing a high prevalence of coronary artery disease (CAD) [28 STEMI (96.6%), 9 NSTEMI (100.0%) and 26 no ACS (68.4%)] requiring percutaneous coronary intervention (PCI) in 52 cases [28 STEMI (96.6%), 8 NSTEMI (88.9%) and 16 no ACS (42.1%)]. Discussion: Coronary angiography immediately after hospital admission is feasible if all are prepared for potential further resuscitation efforts during cardiac catheterization. Primary focus on haemodynamic stabilisation may reduce the rates of coronary angiographies in patients following OHCA. Altogether, our data support the call for immediate coronary angiography in all patients following OHCA irrespective of their initial laboratory or electrocardiographic findings.

Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction

Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention(PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion("ACS" lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and safe but highly effective and there is evidence of improved survival with good neurological outcome. PCI of the culprit lesion is the primary goal while PCI of stable obstructive lesions may be postponed unless post-resuscitation cardiogenic shock is present.

In-Hospital Cardiac Arrest after Emotional Stress in a Patient Hospitalized with Gastrointestinal Symptoms and Chronic Anxiety Disorder

Background:We report an acute emotional stress-induced in-hospital cardiac arrest in a patient admitted with gas-trointestinal symptoms after experiencing chronic anxiety disorder.Case Presentation:The patient was admitted to the Second Xiangya Hospital,Central South University,with gastrointestinal symptoms and chronic anxiety disorder,and experienced cardiac arrest during hospitalization after acute emotional stress.Malignant ventricular tachycardia and cardiogenic shock were evidenced in this patient after the acute emotional stress.Severe and extensive coronary spasm was confi rmed by emergency coronary angiography,and coronary spasm was relieved by intracoronary injection of nitroglycerin.The patient recovered from myocardial infarction with nonobstructive coronary arteries.However,the patient developed acute kidney dysfunction and severe pulmonary infection and eventually died of respiratory circulatory failure on the ninth day after the successful rescue.Conclusions:Acute emotional stress on top of chronic anxiety disorder in patients hospitalized for noncardiovascu-lar reasons might lead to the development of life-threatening cardiovascular diseases,including coronary artery spasm and myocardial infarction with nonobstructive coronary arteries.Psychological management is of importance to im-prove the outcome of these patients.

Out-of-hospital cardiac arrest in a young adult survivor with sequelae of childhood Kawasaki disease: A case report

BACKGROUND Kawasaki disease(KD)is an acute type of systemic vasculitis involving small to medium-sized muscular arteries and outbreaks during childhood.KD can cause myocardial ischemia,infarction,and sudden cardiac arrest.We present a case of a young adult survivor of out-of-hospital cardiac arrest as late KD sequelae.CASE SUMMARY A 29-year-old man with presumed acute KD history at the age of 5 suddenly lost consciousness while jogging and was diagnosed a sudden cardiac arrest by an emergency doctor.After about 10 min cardiopulmonary resuscitation,return of spontaneous circulation was achieved,and the patient was transferred to our hospital.A coronary computed tomography angiogram and coronary angiography revealed extensive calcifications of left anterior descending and right coronary artery aneurysms.The patient was an active individual who took exercise regularly and claimed no previous symptoms of chest pain or shortness of breath on exertion.The most possible cause of his sudden cardiac arrest could be presumed as a thrombus within the coronary artery aneurysms.After that,a thromboembolism induced extensive ischemia,and this ischemia-induced arrhythmia led to a cardiac arrest.CONCLUSION Few patients who suffer a late sequela of KD can survive from out-of-hospital cardiac arrest.Medications,surgical intervention,and active follow-up are extremely important for this patient to prevent occurrence of adverse events in the future.

Are There Age-Related Differences in the In-Hospital Treatment of Victims from Out-of-Hospital Cardiac Arrest?

Objective: Hardly anything is known about reasons for age-related differences in surviving out-of-hospital cardiac arrest (OHCA) with worse surviving rates in elderly. Methods: 204 victims from OHCA who were admitted in our hospital between January 1st 2008 and December 31st 2013 were identified. According to their mean age (69.1 ± 14.2 years) we classified those patients (pts) who were younger than mean age minus standard deviation (SD) as young, and those victims from OHCA who were older than mean age plus SD as old. Results: Young victims from OHCA (n = 32 pts) presented more often with an initial shockable rhythm than the elderly (n = 38 pts) (50.0% vs. 21.1%;p = 0.014), received more often coronary angiography (71.9% vs. 18.4%;

The Role of Cardiac Catheterization after Cardiac Arrest

Coronary angiography after cardiac arrest is important to ascertain potential treatable causes of cardiac arrest,salvage myocardium,and potentially increase long-term survival.The cause of adult out-of-hospital cardiac arrest is typically myocardial ischemia.More than 50% of such resuscitated individuals will have an acutely occluded epicardial coronary on emergency coronary angiography.This includes three in four with ST-segment elevation and one in three without STsegment elevation.In the latter the only reliable method of detection is coronary angiography.Numerous cohort studies,now including more than 8000 patients,have shown an association between survival and early coronary angiography and/or percutaneous coronary intervention.Public reporting of percutaneous coronary intervention 30-day mortality rates has been an impediment for extending this therapy to all resuscitated individuals who experienced out-of-hospital cardiac arrest,since current databases to do fully risk-adjust rates for this subgroup.Sincere efforts are under way to correct this situation.

Impact of emergency percutaneous coronary intervention on outcomes of ST-segment elevation myocardial infarction patients complicated by out-of-hospital cardiac arrest

Background Cardiac arrest is one of the most serious complications of acute myocardial infarction （AMI）, especially in the out-of-hospital patients. There is no general consensus as to whether percutaneous coronary intervention （PCI） is effective in treating ST-segment elevation myocardial infarction （STEMI） patients complicated by out-of-hospital cardiac arrest （OHCA）. In our study, we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality, adverse cardiac events, stroke, acute renal failure, and gastrointestinal bleeding events. Methods A total of 1827 STEMI patients were enrolled in this study, where 81 were STEMI with OHCA. Between the patients with and without OHCA, and the OHCA patients with and without PCI, we compared the clinical characteristics during hospitalization, including total mortality and incidences of adverse cardiac events, and stroke. Results Compared to the patients without OHCA, the OHCA patients had significantly lower systolic blood pressure （P 〈0.05） and a faster heart rate （P〈0.05）, and a higher percentage of Killip class IV or Glasgow coma scale （GCS） 〈7 on admission （P 〈0.001）. And the in-hospital mortality was higher in the OHCA patients （55.6% vs. 2.4%, P 〈0.001）. Comparing the OHCA patients without PCI to the patients with PCI, there was no obvious difference of heart rate, blood pressure or the percentage of Killip class IV and GCS -〈7 on admission, but the incidences of cardiogenic shock, stroke were significantly lower in the with-PCI group during hospitalization （P 〈0.001, P 〈0.05）. And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower （36.7% vs. 84.3%, P 〈0.001）. Conclusions During hospitalization, the incidence of adverse events and mortality are higher in the STEMI with OHCA patients, comparing with the STEMI without OHCA. Emergency PCI reduces the incidence of adverse events and decreases mortality during hospitalization, which is effective for treating STEMI with OHCA patients.

Acute right ventricular myocardial injury and sudden cardiac arrest in a patient with persistent spontaneous coronary vasospasm

Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy,non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous coronaxy vasospasm, leading to right ventricular myocardial injury and failure, and shock. She responded quickly to intravenous normal saline bolus infusion, but had irreversible neurological sequelae. Additionally, she had atrial fibrillation preceding ischemic ventricular fibrillation, a rare finding in coronary vasospasm-related cardiac arrest. We suggest immediate coronary angiography of patients in sudden arrhythmic cardiac arrest with acute right ventricular failure for a prompt,accurate diagnosis and appropriate management of the coronary vasospasm.

Serum sex hormone and growth arrest-specific protein 6 levels in male patients with coronary heart disease

Epidemiological studies have shown a high prevalence of low serum testosterone levels in men with cardiovascular disease. Moreover, the tyrosine kinase receptor Axl, the ligand of which is growth arrest-specific protein 6 （GAS6）, is expressed in the vasculature, and serum GAS6 levels are associated with endothelial dysfunction and cardiovascular events. Testosterone regulates GAS6 gene transcription directly, which inhibits calcification of vascular smooth muscle cells and provides a mechanistic insight into the cardioprotective action of androgens. This study was designed to determine the correlation between serum GAS6 and testosterone levels in male patients with coronary heart disease （CHD）. We recruited 225 patients with CHD and 102 apparently healthy controls, Serum concentrations of GAS6 and soluble Axl were quantified by an enzyme-linked immunosorbent assay. Levels of high-sensitivity C-reactive protein, testosterone, estradiol, and other routine biochemical markers were also measured. Testosterone decreased from 432.69 ± 14.40 to 300.76± 6.23 ng d1-1 （P 〈 0.001） and GAS6 decreased from 16.20± 0.31 to 12.51 ± 0.19 ng ml-1 （P 〈 0.001） in patients with CHD, compared with control subjects. Multiple linear regression analysis showed that serum testosterone and GAS6 levels were positively associated in male patients with CHD. Alterations in GAS6 levels may influence the development of CHD. Downregulation of GAS6/Axl signaling in the presence of low sex hormone levels during disease progression is a potential mechanism by which GAS6 affects CHD. This study provides novel results regarding the influence of sex hormones on serum GAS6 levels in patients with CHD.

Continuous Mechanical Chest Compression-assisted Percutaneous Coronary Intervention in a Patient with Cardiac Arrest Complicating Acute Myocardial Infarction

Cardiac arrest with ventricular tachycardia or ventricular fibrillation in the catheterization laboratory is not uncommon, but patients who suffered cardiac arrest requiring prolonged cardiopulmonary resuscitation is not infrequent and still a major problem, because it is essentially impossible to perform effective manual chest compressions during percutaneous coronary interventions （PCIs）.

静脉-动脉体外膜氧合在经皮冠状动脉介入治疗围术期应用时机的比较

目的 评估经皮冠状动脉介入(PCI)治疗围术期应用体外膜氧合(ECMO)支持的时机对心肌梗死患者的疗效和安全性。方法 回顾性分析2018年1月至2022年8月在中国医学科学院阜外医院接受PCI治疗并应用ECMO支持的患者资料,共计14例患者。根据ECMO启动时机分为预置ECMO支持组(6例)和非预置ECMO支持组(8例)。收集患者的临床资料、PCI治疗情况、机械支持情况、并发症及结局。结果 14例患者平均年龄为(57.9±13.3)岁,男性占12例(85.7%)。预置ECMO支持组主要为三支病变(66.7%),非预置ECMO支持组主要为单支及双支病变(75%)。预置ECMO支持组置入支架中位数和置入球囊中位数均显著高于非预置ECMO支持组(3 vs. 1,P=0.005;6 vs. 2,P=0.020)。预置ECMO支持组PCI中位时间大于非预置ECMO支持组(109 min vs. 27 min,P=0.042)。非预置ECMO支持组死亡率显著高于预置ECMO支持组(75.0%vs. 16.7%,P=0.031),两组患者在相关并发症上无显著差异。结论 预防性应用ECMO支持提高了心肌梗死患者PCI治疗的血运重建率及生存率,且并未增加并发症的发生风险。

两种早期预警评分系统对急性冠状动脉综合征患者发生心搏骤停的预测效果分析

目的探讨两种早期预警评分系统对急性冠状动脉综合征患者发生心搏骤停的预测效果。方法采取回顾性病例-对照研究,便利选取2018年12月至2022年12月因急性冠状动脉综合征入某医院急诊科进行治疗的300例患者作为研究对象,按入院24 h后是否发生心搏骤停分为病例组(158例)和对照组(142例)。病例组收集患者在心搏骤停发生前30 min、1 h、2 h、4 h、8 h、16 h、24 h的生命体征,并带入改良早期预警评分量表和重要性早期预警评分量表;对照组随机选择24 h内具有完整资料的时间点与病例组相对应,收集内容及方法同病例组。结果病例组患者心搏骤停前30 min至24 h各个时间点,两个量表评分均明显高于对照组(P<0.05)。心搏骤停前8 h,改良早期预警评分的ROC曲线下面积为0.642,具有较低的预测效能,重要性早期预警评分的ROC曲线下面积为0.783,预测效能中等。心搏骤停发生前的8 h内,重要性早期预警评分的ROC曲线下面积均>0.7,且各值比较差异均无统计学意义(P>0.05)。重要性早期预警评分对各种类型的急性冠状动脉综合征患者发生心搏骤停的ROC曲线下面积均>0.7。结论重要性早期预警评分比改良早期预警评分具有更高的预测效能,能够提前8 h预测心搏骤停的发生,且对各种类型的急性冠状动脉综合征患者均有良好的预测效果,建议临床推广应用。

急诊PCI联合体外膜肺氧合在抢救急性心肌梗死后心脏骤停患者中的临床效果

目的分析急诊经皮冠状动脉介入治疗(PCI)联合体外膜肺氧合(ECMO)在抢救急性心肌梗死后心脏骤停患者中的应用效果.方法选取本院2021年1月—2023年2月收治的70例急性心肌梗死后心脏骤停患者为研究对象,根据抢救方法将其分为对照组与观察组,每组35例.对照组采用急诊PCI联合常规心肺复苏治疗,观察组采用急诊PCI联合ECMO治疗.比较两组患者的自主循环恢复率、意识状态、格拉斯哥-匹兹堡脑功能表现分级及生存率.结果观察组自主循环恢复率为100%,高于对照组的85.71%,差异有统计学意义(P<0.05).术后1、3 d,观察组GCS评分均高于对照组,组间差异有统计学意义(P<0.05).观察组格拉斯哥-匹兹堡脑功能表现分级≤2级发生率高于对照组,>2级发生率低于对照组,组间差异有统计学意义(P<0.05).观察组随访1年生存率为97.14%,高于对照组的85.71%,差异有统计学意义(P<0.05).结论急诊PCI联合体外膜肺氧合治疗急性心肌梗死后心脏骤停有着较高抢救成功率,改善脑功能,提高生存率,值得推广.

急性冠状动脉综合征导致心脏骤停的预警因素研究进展

急性冠状动脉综合征(ACS)的发病率在我国目前仍呈上升趋势,危重者可发生心脏骤停,心脏骤停后死亡率极高。积极评估患者病情变化,预警心脏骤停的发生,及时给予临床干预,可降低死亡率。目前临床评估方法主要靠预警因素。本文主要从分子生物学、一般临床特征、实验室及辅助检查指标、预警模型及评分等方面对ACS导致心脏骤停的预警因素进行综述。