BACKGROUND Coronary angiography is the standard of care after Out-of-Hospital Cardiac Arrest (OHCA), but its benefit for patients without persistent ST-segment elevation (STE) remains controversial. METHODS All patients admitted for coronary angiography after a resuscitated OHCA were consecutively included in this prospective study. Three patient groups were defined according to post-resuscitation ECG: STE or new left bundle branch block (LBBB) (group 1); other ST/T repolarization disorders (group 2) and no repolarisation disorders (group 3). The proportion and predictive factors of an acute coronary lesion, defined by acute coronary occlusion or thrombotic lesion or lesion associated with flow impairment, were evaluated according to different groups as well as thirty-day mortality. RESULTS Among 129 consecutive patients: 62 (48.1%), 30 (23.3%) and 30 (23.3%) patients were included in groups 1, 2 and 3 respectively. An acute coronary lesion was observed in 43% (n = 55) of patients, mainly in group 1 (n = 44, 70.9%). Initial coronary TIMI 0/1 flow was more frequently observed in group 1 than in group 2 (n = 25, 40.3% vs n = 1, 3.3%) and never in group 3. Chest pain and STE or new LBBB were independently associated with an acute coronary lesion (adj. OR = 7.14 [1.85-25.00]; p = 0.004 and adj. OR = 11.10 [3.70-33.33]; p < 0.001 respectively). In absence of any repolarization disorders, acute coronary lesion or occlusion were excluded with negative predictive values of 93.3% and 100% respectively. The one-month survival rate was 38.8% and was better in patients among the group 1 compared to those from the 2 other groups (n = 28, 45.2% vs n = 21, 35%, respectively; p = 0.014). CONCLUSION Considering the high negative predictive value of post-resuscitation ECG to exclude acute coronary lesion and occlusion after OHCA, a delayed coronary angiography appears a reliable alternative for patients without repolarization disorders.

中文翻译：

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院外心脏骤停后的复苏后心电图检查可用于冠状动脉造影。

背景技术冠状动脉造影术是院外心脏骤停（OHCA）后的护理标准，但是其对于没有持续性ST段抬高（STE）的患者的益处仍存在争议。方法本研究纳入了所有在OHCA复苏后接受冠状动脉造影的患者。根据复苏后的心电图定义了三个患者组：STE或新的左束支传导阻滞（LBBB）（组1）；其他ST / T复极障碍（第2组），无复极障碍（第3组）。急性冠状动脉病变的比例和预测因素由急性冠状动脉闭塞或血栓性病变或与血流障碍相关的病变定义，并根据不同的组以及30天的死亡率进行评估。结果在连续129例患者中：62（48.1％），30（23。第1、2和3组分别包括3％）和30（23.3％）名患者。在43％（n = 55）的患者中观察到急性冠状动脉病变，主要在第1组（n = 44，70.9％）。第1组比第2组更常见初始冠状动脉TIMI 0/1血流（n = 25，40.3％vs n = 1，3.3％），而在第3组则从未如此。胸痛和STE或新LBBB与急性冠状动脉病变（调整OR = 7.14 [1.85-25.00]； p = 0.004和调整OR = 11.10 [3.70-33.33]； p <0.001）。在没有任何复极障碍的情况下，急性冠脉病变或闭塞被排除，阴性预测值分别为93.3％和100％。与其他2组相比，第1组患者的1个月生存率是38.8％，更好（n = 28，45.2％，n = 21，35％； p = 0.014）。