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Abstract 16386: Predicting Cardiac Arrest Myocardial Infarction (PreCAMI) in Out of Hospital Cardiac Arrest (OHCA) Survivors Lacking ST Elevations (STE)
Ist Teil von
Circulation (New York, N.Y.), 2015-11, Vol.132 (Suppl_3 Suppl 3), p.A16386-A16386
Ort / Verlag
by the American College of Cardiology Foundation and the American Heart Association, Inc
Erscheinungsjahr
2015
Link zum Volltext
Quelle
Alma/SFX Local Collection
Beschreibungen/Notizen
IntroductionCoronary angiography (CA) and percutaneous intervention (PCI) after OHCA is recommended for suspected coronary occlusion based on ST elevation (STE) by ECG, yet 20-40% of OHCA patients without STE also have occlusions.HypothesisClinical criteria available prior to CA can be used to create a score to predict whether PCI will be attempted in non-STE OHCA patients with sensitivity (Sn) and specificity (Sp) nearing STE. Attempted PCI in non-STE OHCA will be associated with improved survival and functional outcomes.MethodsWe abstracted historical, demographic, resuscitation, ECG and lab data available within 6h of hospitalization in 156 non-STE OHCA who underwent early CA (<24h after OHCA). Logistic regression models tested associations between clinical variables and attempted PCI (model entry criteria p<0.1; stay criteria p<0.15). In these subjects and 304 non-STE OHCA who had delayed/absent CA, propensity adjusted regression examined associations of early CA (regardless of PCI attempt) or PCI attempt with survival or functional recovery (cerebral performance category 1-2, modified Rankin score 0-3 or discharge home or rehabilitation). Independent validation of score Sn and Sp was performed in a cohort where CA in non-STE OHCA is frequent (Cochin registry).Results61/156 (39.1%) OHCA subjects without STE had attempted PCI. We derived a 4 variable (initial troponin, male sex, VF/VT presentation, epinephrine doses during CPR) parsimonious model (AUROC 0.78) which predicted PCI attempt with Sn 83%/Sp 51% comparing favorably to STE at our center (Sn 62%/Sp 77%). In Cochin 111/467 (24%) of CA resulted in PCI. Score validation in 407 OHCA with complete data yielded Sn 68%/Sp 50% for predicting PCI use in CA. Attempted PCI, but not CA alone, was associated with improved outcomes (US cohort). (Table).ConclusionWeʼve validated a 4 variable score which predicts PCI use in OHCA without STE. PCI use in this population is associated with improved outcomes.