Indications and Timing of Coronary Angiography in Survivors of an Out-of-Hospital Cardiac Arrest

Abstract

Unstable coronary artery lesions are the main cause of out-of-hospital cardiac arrest. Primary percutaneous coronary intervention seems to improve prognosis. In the absence of randomized trials, current guidelines are based on registry data. An immediate coronary angiogram should be done at hospital admission for survivors of outof- hospital cardiac arrest if an electrocardiogram performed after return of spontaneous circulation shows ST segment elevation. In the other cases, it is recommended to search for a non-cardiac cause of arrest by performing a cerebral and thoracic CT scan. If a non-cardiac cause is not the cause of arrest, a coronary angiogram should be performed emergently, less than two hours after hospital admission. If a culprit lesion is found, primary percutaneous coronary intervention should be performed at best using a radial approach and drug eluting stents. In survivors, a deferred coronary angiogram may be indicated to treat non-culprit lesions or to perform a provocative test for coronary spasm in patients with a normal coronary angiogram at the first procedure.