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Coronary Angiography and Intervention in Women Resuscitated From Sudden Cardiac Death.

ABSTRACT: Background Coronary artery disease is the primary etiology for sudden cardiac arrest in adults, but potential differences in the incidence and utility of invasive coronary testing between resuscitated men and women have not been extensively evaluated. Our aim was to characterize angiographic similarities and differences between men and women after cardiac arrest. Methods and Results Data from the International Cardiac Arrest Registry-Cardiology database included patients resuscitated from out-of-hospital cardiac arrest of presumed cardiac origin, admitted to 7 academic cardiology/resuscitation centers during 2006 to 2017. Demographics, clinical factors, and angiographic findings of subjects were evaluated in relationship to sex and multivariable logistic regression models created to predict both angiography and outcome. Among 966 subjects, including 277 (29%) women and 689 (71%) men, fewer women had prior coronary artery disease and more had prior congestive heart failure (P=0.05). Women were less likely to have ST-segment-elevation myocardial infarction (32% versus 39%, P=0.04). Among those with ST-segment-elevation myocardial infarctions, identification and distribution of culprit arteries was similar between women and men, and there were no differences in treatment or outcome. In patients without ST-segment elevation post-arrest, women were overall less likely to undergo coronary angiography (51% versus 61%, P<0.02), have a culprit vessel identified (29% versus 45%, P=0.03), and had fewer culprits acutely occluded (17% versus 28%, P=0.03). Women were also less often re-vascularized (44% versus 52%, P<0.03). Conclusions Among cardiac arrest survivors, women are less likely to undergo angiography or percutaneous coronary intervention than men. Sex disparities for invasive therapies in post-cardiac arrest care need continued attention.

SUBMITTER: May T

PROVIDER: S-EPMC7428608 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Coronary Angiography and Intervention in Women Resuscitated From Sudden Cardiac Death.

May Teresa T Skinner Kristina K Unger Barbara B Mooney Michael M Patel Nainesh N Dupont Allison A McPherson John J McMullan Paul P Nielsen Niklas N Seder David B DB Kern Karl B KB

Journal of the American Heart Association 20200325 7

Background Coronary artery disease is the primary etiology for sudden cardiac arrest in adults, but potential differences in the incidence and utility of invasive coronary testing between resuscitated men and women have not been extensively evaluated. Our aim was to characterize angiographic similarities and differences between men and women after cardiac arrest. Methods and Results Data from the International Cardiac Arrest Registry-Cardiology database included patients resuscitated from out-of ...[more]

PMID: 32208830

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Project description:BackgroundIn patients resuscitated from cardiac arrest and displaying no ST-segment elevation on initial electrocardiogram (ECG), recent randomized trials indicated no benefits from early coronary angiography. How the results of such randomized studies apply to a real-world clinical context remains to be established.MethodsWe retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses.ResultsWe analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients.ConclusionsOur results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation.

Project description:AimsThe aim of this study was to examine the effect of dapagliflozin on the incidence of ventricular arrhythmias and sudden death in patients with heart failure and reduced ejection fraction (HFrEF).Methods and resultsIn a post hoc analysis of DAPA-HF, we examined serious adverse event reports related to ventricular arrhythmias or cardiac arrest, in addition to adjudicated sudden death. The effect of dapagliflozin, compared with placebo, on the composite of the first occurrence of any serious ventricular arrhythmia, resuscitated cardiac arrest, or sudden death was examined using Cox proportional hazards models. A serious ventricular arrhythmia was reported in 115 (2.4%) of the 4744 patients in DAPA-HF (ventricular fibrillation in 15 patients, ventricular tachycardia in 86, 'other' ventricular arrhythmia/tachyarrhythmia in 12, and torsade de pointes in 2 patients). A total of 206 (41%) of the 500 cardiovascular deaths occurred suddenly. Eight patients survived resuscitation from cardiac arrest. Independent predictors of the composite outcome (first occurrence of any serious ventricular arrhythmia, resuscitated cardiac arrest or sudden death), ranked by chi-square value, were log-transformed N-terminal pro-B-type natriuretic peptide, history of ventricular arrhythmia, left ventricular ejection fraction, systolic blood pressure, history of myocardial infarction, male sex, body mass index, serum sodium concentration, non-white race, treatment with dapagliflozin, and cardiac resynchronization therapy. Of participants assigned to dapagliflozin, 140/2373 patients (5.9%) experienced the composite outcome compared with 175/2371 patients (7.4%) in the placebo group [hazard ratio 0.79 (95% confidence interval 0.63-0.99), P = 0.037], and the effect was consistent across each of the components of the composite outcome.ConclusionsDapagliflozin reduced the risk of any serious ventricular arrhythmia, cardiac arrest, or sudden death when added to conventional therapy in patients with HFrEF.Clinical trial registrationClinicalTrials.gov unique identifier: NCT03036124 (DAPA-HF).

Project description:Introduction and importanceVarious artifacts mimicked aortic dissection, such as streak artifacts generated by high-attenuation material, high-contrast interfaces, cardiac motion, periaortic structures, aortic wall motion, and normal aortic sinuses, have been described in the literature. Most artifacts that simulate ascending aortic dissection occur frequently on conventional CT. Their position is predictable and is related to systolic aortic motion. However, so far, to the best of our knowledge, this is the first pseudo-aortic dissection reported during coronary angiography in cardiac arrest.Case presentationWe report a case of a middle-aged man transferred to our hospital after an out-of-hospital cardiac arrest. The coronary angiography revealed non-obstructive coronary arteries and an image of probable aortic dissection was observed. Given the persistent asystole despite a prolonged advance cardiopulmonary resuscitation and the possibility of aortic dissection, a prompt in-room heart team discussion was performed. It was decided to stop and withdraw potentially life-sustaining treatment due to futility. The necropsy study revealed the aorta with some mild atherosclerotic plaques but without either aneurysm or thrombosis. The coronary arteries were reported as with patency, but in the proximal left anterior descending artery (LAD), the intima layer presented a thickness that decreased 50 % of the luminal area without signs of complicated acute plaques.Clinical discussionIn this case, the systolic aortic motion theory cannot explain the false-aortic dissection image in the coronary angiography because the patient was under cardiac arrest. Studies with arterial and venous pressures devices recording in cardiac arrest, demonstrated an abnormal hemodynamic flow, suggesting that the hemodynamic flow might be backward during cardiopulmonary resuscitation Therefore, in the setting of this abnormal hemodynamic flow, the injection of contrast may have an abnormal distribution and flow in the aorta creating an image of pseudo-aortic dissection.ConclusionAlthough the exact mechanism of this false-positive aortic dissection in cardiac arrest remains unknown, operators should be aware of this entity during coronary angiography in the setting of cardiac arrest with mechanical chest compressions to avoid diagnostic errors in clinical practice.

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Coronary Angiography and Intervention in Women Resuscitated From Sudden Cardiac Death.

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Coronary Angiography and Intervention in Women Resuscitated From Sudden Cardiac Death.

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