Kumar Sachin, Abdelghaffar Bahaa, Iyer Meghana, Shamaileh Ghaith, Nair Raunak, Zheng Weili, Verma Beni, Menon Venu, Kapadia Samir R, Reed Grant W
Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
J Soc Cardiovasc Angiogr Interv. 2022 Nov 25;2(1):100536. doi: 10.1016/j.jscai.2022.100536. eCollection 2023 Jan-Feb.
Out-of-hospital cardiac arrest (OHCA) is among the most common causes of death in the United States. Early coronary angiography (CAG) and percutaneous coronary intervention (PCI) have been associated with improved long-term outcomes in patients with ST-segment elevation (STE) on prearrest or postarrest electrocardiograms. However, data on the utility of catheterization and PCI for improving outcomes after OHCA in patients without STE on electrocardiograms are heterogeneous, with variable results. Although older data have suggested that there is a benefit, recent randomized controlled trials have demonstrated that performing early CAG in patients with OHCA without STE on electrocardiograms may not improve outcomes. In recognition that neurologic devastation and multiorgan failure are common in these patients, physicians face the challenge of selecting appropriate patients for cardiac catheterization and PCI. This review aims to summarize the current data on this topic, with the goal to guide decision making regarding the timing and appropriateness of CAG in patients with OHCA without STE on electrocardiograms, utilizing an evidence-based approach to streamline the patient selection process.
院外心脏骤停（OHCA）是美国最常见的死因之一。早期冠状动脉造影（CAG）和经皮冠状动脉介入治疗（PCI）与心脏骤停前或心脏骤停后心电图显示ST段抬高（STE）患者的长期预后改善相关。然而，关于在心电图无STE的OHCA患者中进行心导管插入术和PCI以改善预后的数据并不一致，结果也各不相同。尽管早期数据表明存在益处，但最近的随机对照试验表明，在心电图无STE的OHCA患者中进行早期CAG可能无法改善预后。鉴于这些患者中神经功能损害和多器官功能衰竭很常见，医生面临着为心脏导管插入术和PCI选择合适患者的挑战。本综述旨在总结关于这一主题的当前数据，目标是利用循证方法简化患者选择过程，指导在心电图无STE的OHCA患者中进行CAG的时机和适宜性决策。
