Coronary angiographic findings for out-of-hospital cardiac arrest survivors presenting with nonshockable rhythms and no ST elevation post resuscitation br

Background: Recent guidelines suggest that coronary angiography (CAG) should be considered for out-of-hospital cardiac arrest (OHCA) sur-vivors, including those without ST elevation (STE) and without shockable rhythms. However, there is no prospective data to support CAG for sur-vivors with nonshockable rhythms and no STE post resuscitation.Methods: This was a re-analysis of the PEARL study (randomized OHCA survivors without STE to early CAG versus not). Patients were subdivided by initial rhythm as nonshockable (Nsh) vs shockable (Sh). The primary outcome was coronary angiographic evidence of acute culprit lesion, with secondary outcomes being survival to hospital discharge and neurological recovery.Results: The PEARL study included 99 patients with OHCA from a presumed cardiac etiology, 24 with nonshockable and 75 with shockable rhythms. There was no difference in the frequency of CAG between the two groups [71% (Nsh) and 75% (Sh); p = 0.79], presence of CAD [81% (Nsh) and 68% (sh); p = 0.37, or culprit lesions identified in each group [50% (Nsh) and 45% (Sh); p = 0.78. Nonshockable patients had worse discharge survival [33% (Nsh) vs 57% (Sh); p = 0.04] and those survived, had worse neurological recovery [30% (Nsh) vs 54% (Sh); p = 0.02] com-pared to shockable patients.Conclusions: OHCA survivors presenting with nonshockable rhythms and no STE post resuscitation had similar prevalence of culprit coronary lesions to those with shockable rhythms. CAG may be considered in patients with OHCA without STE regardless of initial presenting rhythm. There was no benefit of emergent CAG both in shockable and non-shockable rhythms.

Automated summary

Recent studies suggest that coronary angiography (CAG) should be considered for out-of-hospital cardiac arrest (OHCA) survivors, regardless of ST elevation (STE) and shockable rhythms. This re-analysis of the PEARL study found that OHCA survivors with nonshockable rhythms and no STE had similar prevalence of culprit coronary lesions as those with shockable rhythms. However, there was no benefit of emergent CAG for both shockable and nonshockable rhythms.