High rate of critical coronary stenosis in comatose patients with Non-ST-elevation out-of-hospital cardiac arrest (NSTE-OHCA) undergoing therapeutic hypothermia-Experience from the HAnnover COoling REgistry (HACORE).

<h4>Background</h4>Myocardial infarction is the most frequent cause for out-of-hospital cardiac arrest (OHCA) in adults. Patients with ST-segment elevations (STE) following return of spontaneous circulation (ROSC) are regularly admitted to the catheterisation laboratory for urgent corona...

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Autores principales:	Vera Garcheva, Muharrem Akin, John Adel, Carolina Sanchez Martinez, Johann Bauersachs, Andreas Schäfer
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/9906da444f994b3dadf844282a9533de
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spelling	oai:doaj.org-article:9906da444f994b3dadf844282a9533de2021-11-25T06:19:19ZHigh rate of critical coronary stenosis in comatose patients with Non-ST-elevation out-of-hospital cardiac arrest (NSTE-OHCA) undergoing therapeutic hypothermia-Experience from the HAnnover COoling REgistry (HACORE).1932-620310.1371/journal.pone.0251178https://doaj.org/article/9906da444f994b3dadf844282a9533de2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251178https://doaj.org/toc/1932-6203<h4>Background</h4>Myocardial infarction is the most frequent cause for out-of-hospital cardiac arrest (OHCA) in adults. Patients with ST-segment elevations (STE) following return of spontaneous circulation (ROSC) are regularly admitted to the catheterisation laboratory for urgent coronary angiography. Whether patients without obvious STE (NSTE) should receive coronary angiography as part of a standardised diagnostic work-up following OHCA is still debated.<h4>Methods</h4>We analysed a cohort of 517 subsequent OHCA patients admitted at our institution who received a standardised diagnostic work-up including coronary angiography and therapeutic hypothermia. Patients were 63±14 years old, 76% were male. Overall, 180 (35%) had ST-elevation in the post-ROSC ECG, 317 (61%) had shockable rhythm (ventricular fibrillation or tachycardia) at first ECG. ROSC was achieved after 26±21 minutes.<h4>Results</h4>Critical coronary stenosis requiring PCI was present in 83% of shockable and 87% of non-shockable STE-OHCA and in 48% of shockable and 22% of non-shockable NSTE-OHCA patients. In-hospital survival was 61% in shockable and 55% in non-shockable STE-OHCA and 60% in shockable and 28% in non-shockable NSTE-OHCA.<h4>Conclusion</h4>Standardised admission diagnostics in OHCA patients undergoing therapeutic hypothermia with a strict admission protocol incorporating ECG and coronary catheterisation shows a high rate of relevant coronary stenosis in STE-OHCA irrespective of the initial rhythm and in NSTE-OHCA with initial shockable rhythm. Based on the unfavourable outcome and low PCI rate observed in NSTE-OHCA patients with a primary non-shockable ECG rhythm it might be reasonable to restrict routine early coronary angiography to patients with primary shockable rhythms and/or ST-segment elevations after ROSC.Vera GarchevaMuharrem AkinJohn AdelCarolina Sanchez MartinezJohann BauersachsAndreas SchäferPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0251178 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Vera Garcheva Muharrem Akin John Adel Carolina Sanchez Martinez Johann Bauersachs Andreas Schäfer High rate of critical coronary stenosis in comatose patients with Non-ST-elevation out-of-hospital cardiac arrest (NSTE-OHCA) undergoing therapeutic hypothermia-Experience from the HAnnover COoling REgistry (HACORE).
description	<h4>Background</h4>Myocardial infarction is the most frequent cause for out-of-hospital cardiac arrest (OHCA) in adults. Patients with ST-segment elevations (STE) following return of spontaneous circulation (ROSC) are regularly admitted to the catheterisation laboratory for urgent coronary angiography. Whether patients without obvious STE (NSTE) should receive coronary angiography as part of a standardised diagnostic work-up following OHCA is still debated.<h4>Methods</h4>We analysed a cohort of 517 subsequent OHCA patients admitted at our institution who received a standardised diagnostic work-up including coronary angiography and therapeutic hypothermia. Patients were 63±14 years old, 76% were male. Overall, 180 (35%) had ST-elevation in the post-ROSC ECG, 317 (61%) had shockable rhythm (ventricular fibrillation or tachycardia) at first ECG. ROSC was achieved after 26±21 minutes.<h4>Results</h4>Critical coronary stenosis requiring PCI was present in 83% of shockable and 87% of non-shockable STE-OHCA and in 48% of shockable and 22% of non-shockable NSTE-OHCA patients. In-hospital survival was 61% in shockable and 55% in non-shockable STE-OHCA and 60% in shockable and 28% in non-shockable NSTE-OHCA.<h4>Conclusion</h4>Standardised admission diagnostics in OHCA patients undergoing therapeutic hypothermia with a strict admission protocol incorporating ECG and coronary catheterisation shows a high rate of relevant coronary stenosis in STE-OHCA irrespective of the initial rhythm and in NSTE-OHCA with initial shockable rhythm. Based on the unfavourable outcome and low PCI rate observed in NSTE-OHCA patients with a primary non-shockable ECG rhythm it might be reasonable to restrict routine early coronary angiography to patients with primary shockable rhythms and/or ST-segment elevations after ROSC.
format	article
author	Vera Garcheva Muharrem Akin John Adel Carolina Sanchez Martinez Johann Bauersachs Andreas Schäfer
author_facet	Vera Garcheva Muharrem Akin John Adel Carolina Sanchez Martinez Johann Bauersachs Andreas Schäfer
author_sort	Vera Garcheva
title	High rate of critical coronary stenosis in comatose patients with Non-ST-elevation out-of-hospital cardiac arrest (NSTE-OHCA) undergoing therapeutic hypothermia-Experience from the HAnnover COoling REgistry (HACORE).
title_short	High rate of critical coronary stenosis in comatose patients with Non-ST-elevation out-of-hospital cardiac arrest (NSTE-OHCA) undergoing therapeutic hypothermia-Experience from the HAnnover COoling REgistry (HACORE).
title_full	High rate of critical coronary stenosis in comatose patients with Non-ST-elevation out-of-hospital cardiac arrest (NSTE-OHCA) undergoing therapeutic hypothermia-Experience from the HAnnover COoling REgistry (HACORE).
title_fullStr	High rate of critical coronary stenosis in comatose patients with Non-ST-elevation out-of-hospital cardiac arrest (NSTE-OHCA) undergoing therapeutic hypothermia-Experience from the HAnnover COoling REgistry (HACORE).
title_full_unstemmed	High rate of critical coronary stenosis in comatose patients with Non-ST-elevation out-of-hospital cardiac arrest (NSTE-OHCA) undergoing therapeutic hypothermia-Experience from the HAnnover COoling REgistry (HACORE).
title_sort	high rate of critical coronary stenosis in comatose patients with non-st-elevation out-of-hospital cardiac arrest (nste-ohca) undergoing therapeutic hypothermia-experience from the hannover cooling registry (hacore).
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/9906da444f994b3dadf844282a9533de
work_keys_str_mv	AT veragarcheva highrateofcriticalcoronarystenosisincomatosepatientswithnonstelevationoutofhospitalcardiacarrestnsteohcaundergoingtherapeutichypothermiaexperiencefromthehannovercoolingregistryhacore AT muharremakin highrateofcriticalcoronarystenosisincomatosepatientswithnonstelevationoutofhospitalcardiacarrestnsteohcaundergoingtherapeutichypothermiaexperiencefromthehannovercoolingregistryhacore AT johnadel highrateofcriticalcoronarystenosisincomatosepatientswithnonstelevationoutofhospitalcardiacarrestnsteohcaundergoingtherapeutichypothermiaexperiencefromthehannovercoolingregistryhacore AT carolinasanchezmartinez highrateofcriticalcoronarystenosisincomatosepatientswithnonstelevationoutofhospitalcardiacarrestnsteohcaundergoingtherapeutichypothermiaexperiencefromthehannovercoolingregistryhacore AT johannbauersachs highrateofcriticalcoronarystenosisincomatosepatientswithnonstelevationoutofhospitalcardiacarrestnsteohcaundergoingtherapeutichypothermiaexperiencefromthehannovercoolingregistryhacore AT andreasschafer highrateofcriticalcoronarystenosisincomatosepatientswithnonstelevationoutofhospitalcardiacarrestnsteohcaundergoingtherapeutichypothermiaexperiencefromthehannovercoolingregistryhacore
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High rate of critical coronary stenosis in comatose patients with Non-ST-elevation out-of-hospital cardiac arrest (NSTE-OHCA) undergoing therapeutic hypothermia-Experience from the HAnnover COoling REgistry (HACORE).

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