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Picard F, Munnich B, Brami P, Sava R, Pham V, Cariou A, Varenne O. Clinical and angiographic characteristics of out-of-hospital cardiac arrest among patients with ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 2024; 117:153-159. [PMID: 38267318 DOI: 10.1016/j.acvd.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is the most severe complication of ST-segment elevation myocardial infarction (STEMI). Nevertheless, clinical and angiographic characteristics associated with OHCA among patients with STEMI have not been studied extensively. AIM To evaluate the clinical and angiographic characteristics of consecutive patients who presented with STEMI associated or not with OHCA. METHODS This was an observational study including consecutive patients treated for STEMI associated or not with OHCA. Baseline clinical and angiographic characteristics, biological characteristics and mortality were compared between patients with STEMI who experienced OHCA and patients with STEMI who did not. RESULTS Among the 686 included patients with STEMI, 148 (21.6%) presented with concomitant OHCA. Multivariable analysis revealed that culprit lesion localized on the left system (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.24-3.13; P<0.01), culprit lesion at the level of a bifurcation lesion (OR 1.87, 95% CI 1.21-2.88; P<0.01) and the presence of chronic total occlusion on another artery (OR 3.39, 95% CI 1.93-5.99; P<0.001) were associated with the occurrence of OHCA, whereas dyslipidaemia, familial history of coronary artery disease and hypertension were found to be negatively associated with the occurrence of OHCA in patients with STEMI: OR 0.47, 95% CI 0.29-0.75 (P<0.01); OR 0.09, 95% CI 0.02-0.25 (P<0.001); and OR 0.60, 95% CI 0.38-0.93 (P=0.02), respectively. CONCLUSION In this study of consecutive patients with STEMI, culprit lesion localized on the left system, culprit lesion at the level of a bifurcation lesion and the presence of chronic total occlusion on a non-culprit artery were associated with OHCA.
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Affiliation(s)
- Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France; Université Paris-Cité, 75014 Paris, France.
| | - Benjamin Munnich
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Pierre Brami
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France; Université Paris-Cité, 75014 Paris, France
| | - Ruxandra Sava
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Vincent Pham
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Alain Cariou
- Université Paris-Cité, 75014 Paris, France; Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France; Université Paris-Cité, 75014 Paris, France
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Macherey-Meyer S, Heyne S, Meertens MM, Braumann S, Niessen SF, Baldus S, Lee S, Adler C. Outcome of Out-of-Hospital Cardiac Arrest Patients Stratified by Pre-Clinical Loading with Aspirin and Heparin: A Retrospective Cohort Analysis. J Clin Med 2023; 12:3817. [PMID: 37298012 PMCID: PMC10253358 DOI: 10.3390/jcm12113817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Background: Out-of-hospital cardiac arrest (OHCA) has a high prevalence of obstructive coronary artery disease and total coronary occlusion. Consequently, these patients are frequently loaded with antiplatelets and anticoagulants before hospital arrival. However, OHCA patients have multiple non-cardiac causes and high susceptibility for bleeding. In brief, there is a gap in the evidence for loading in OHCA patients. Objective: The current analysis stratified the outcome of patients with OHCA according to pre-clinical loading. Material and Methods: In a retrospective analysis of an all-comer OHCA registry, patients were stratified by loading with aspirin (ASA) and unfractionated heparin (UFH). Bleeding rate, survival to hospital discharge and favorable neurological outcomes were measured. Results: Overall, 272 patients were included, of whom 142 were loaded. Acute coronary syndrome was diagnosed in 103 patients. One-third of STEMIs were not loaded. Conversely, 54% with OHCA from non-ischemic causes were pretreated. Loading was associated with increased survival to hospital discharge (56.3 vs. 40.3%, p = 0.008) and a more favorable neurological outcome (80.7 vs. 62.6% p = 0.003). Prevalence of bleeding was comparable (26.8 vs. 31.5%, p = 0.740). Conclusions: Pre-clinical loading did not increase bleeding rates and was associated with favorable survival. Overtreatment of OHCA with non-ischemic origin, but also undertreatment of STEMI-OHCA were documented. Loading without definite diagnosis of sustained ischemia is debatable in the absence of reliable randomized controlled data.
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Affiliation(s)
- Sascha Macherey-Meyer
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (S.H.); (M.M.M.); (S.B.); (S.F.N.); (S.B.); (S.L.); (C.A.)
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Brami P, Picard F, Seret G, Fischer Q, Pham V, Varenne O. Intracoronary imaging in addition to coronary angiography for patients with out-of-hospital cardiac arrest: More information for better care? Arch Cardiovasc Dis 2023; 116:272-281. [PMID: 37117094 DOI: 10.1016/j.acvd.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/30/2023]
Abstract
About 70% of out-of-hospital cardiac arrests are related to an ischaemic heart disease in Western countries. Percutaneous coronary intervention has been shown to improve the prognosis of survivors when an unstable coronary lesion is identified as the potential cause of the cardiac arrest. Acute complete coronary occlusion is often demonstrated among patients with ST-segment elevation on electrocardiogram after the return of spontaneous circulation. In patients without ST-segment elevation, routine coronary angiography has been shown to be not superior to conservative management. However, an electrocardiogram-based decision to perform immediate coronary angiography could be insufficient to identify unstable coronary lesions, which are frequently associated with intermediate coronary stenosis. Intracoronary imaging can be helpful to detect plaque rupture or erosion and intracoronary thrombus, but could also lead to better stent implantation, and help to reduce the risk of stent thrombosis. In patients with coronary lesions without the instability characteristic, conservative management should be the default strategy, and a search for another cause of the cardiac arrest should be systematic. In the present review, we sought to describe the potential benefit of intracoronary imaging in patients with out-of-hospital cardiac arrest.
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Affiliation(s)
- Pierre Brami
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France
| | - Gabriel Seret
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Quentin Fischer
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Vincent Pham
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France; Centre d'expertise sur la mort subite (CEMS), 75015 Paris, France.
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Pham V, Varenne O, Cariou A, Picard F. Prognosis of out-of-hospital cardiac arrest due to acute myocardial infarction with or without ST-segment elevation in patients treated with percutaneous coronary intervention. Arch Cardiovasc Dis 2023; 116:227-229. [PMID: 36858910 DOI: 10.1016/j.acvd.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Vincent Pham
- Department of Cardiology, hôpital Cochin, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Olivier Varenne
- Department of Cardiology, hôpital Cochin, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Alain Cariou
- Université Paris Cité, 75006 Paris, France; Medical Intensive Care Unit, hôpital Cochin, hôpitaux universitaire Paris centre, AP-HP, 75014 Paris, France; Inserm U970, Paris Cardiovascular Research Center (PARCC), Georges-Pompidou European Hospital, 75015 Paris, France
| | - Fabien Picard
- Department of Cardiology, hôpital Cochin, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Cité, 75006 Paris, France; Inserm U970, Paris Cardiovascular Research Center (PARCC), Georges-Pompidou European Hospital, 75015 Paris, France
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Maqsood MH, Ashish K, Truesdell AG, Belford PM, Zhao DX, Rab ST, Vallabhajosyula S. Role of adjunct anticoagulant or thrombolytic therapy in cardiac arrest without ST-segment-elevation or percutaneous coronary intervention: A systematic review and meta-analysis. Am J Emerg Med 2023; 63:1-4. [PMID: 36279808 DOI: 10.1016/j.ajem.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 12/07/2022] Open
Abstract
This study sought to compare the impact of additional anticoagulation or thrombolytic therapy in patients with cardiac arrest without ST-segment-elevation on electrocardiography and not receiving percutaneous coronary intervention. Three studies (two randomized controlled studies and one observational study) were included, which demonstrated that use of anticoagulation or thrombolytic therapy was associated with higher risk of bleeding, without improvements in time to return of spontaneous circulation or in-hospital mortality.
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Affiliation(s)
| | - Kumar Ashish
- Department of Medicine, CarolinaEast Medical Center, New Bern, NC, United States of America
| | - Alexander G Truesdell
- Virginia Heart/Inova Heart and Vascular Institute, Falls Church, VA, United States of America
| | - P Matthew Belford
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - S Tanveer Rab
- Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America.
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Seret G, Pham V, Laghlam D, Diefenbronn M, Brunet T, Varenne O, Dumas F, Cariou A, Picard F. Performance of stent thrombosis and bleeding risk scores in out-of-hospital cardiac arrest due to acute coronary syndromes. Arch Cardiovasc Dis 2022; 115:552-561. [DOI: 10.1016/j.acvd.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/02/2022]
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