Purpose:

It is still under debate whether patients after out-of-hospital cardiac arrest (OHCA) without ST-Elevation on ECG (NSTE-OHCA) should undergo immediate coronary angiography. We examined neurological outcome in patients with immediate coronary angiography and percutaneous coronary intervention (PCI) following successful resuscitation after NSTE-OHCA compared to OHCA patients who showed ST-elevation in their ECG (STE-OHCA).

Methods:

HACORE is an observational, prospective registry of all OHCA patients admitted to our institution and receiving therapeutic hypothermia. Patients undergo a coronary angiogram prior to ICU admission if there is no evidence of non-cardiac cause of arrest and standard intensive care is provided including additional therapeutic hypothermia.

Results:

Mean age of the overall patient population (n=504) was 61±19 years (STE-OHCA n=187, mean age 60±15 years vs. NSTE-OHCA n=317; mean age 61±21) with a male predominance (76%; STE-OHCA 82% vs NSTE-OHCA 72%). Cardiac arrest was witnessed in 79% (83% vs 77%) and bystander cardiopulmonal resuscitation was performed in 66% (69% vs 62%). Initial rhythm was ventricular fibrillation in 62% (78% vs 52%). ROSC had been achieved after 26±21 (26±21 vs. 25±21) minutes. Hypothermia was applied in all patients, percutaneous coronary angiography in 92%, and coronary intervention in 54%. After ROSC, STE-OHCA was present in 37%. Critical coronary stenosis requiring PCI was present in 82% in STE-OHCA as compared to 36% in NSTE-OHCA. Mechanical support was required in 8% of STE-OHCA and 4% of NSTE-OHCA population. 30 day mortality was 45% in the total cohort, 32% in STE-OHCA and 50% in NSTE-OHCA. After intensive care and discharge from neurological rehabilitation good neurological outcome according to Cerebral Performance Score ≤2 was achieved in 71% of STE-OHCA versus 62% in NSTE-OHCA-population, and poor neurological outcome in survivors was present in 29% of STE-OHCA vs. 38% in NSTE-OHCA population.

Conclusion:

Stenotic coronary disease is predominant in OHCA patients independent of presence of ST-elevations. There is no significant difference in either 30 day mortality or favorable neurological outcome regarding the presence or absence of ST-elevations after OHCA. OHCA patients without STE showed a high proportion of relevant coronary stenosis, which often required coronary intervention. In our experience from HACORE, NSTE-OHCA should receive a similar invasive approach as it is standard for STE-OHCA.