1. Floriane Zeyons, MD University Hospital of Strasbourg, France
Out-of-hospital cardiac arrest survivors sent for emergency angiography: a clinical score for predicting acute myocardial infarction
Floriane Zeyons, Laurence Jesel, Olivier Morel, Hélène Kremer, Nathan Messas, Sebastien Hess, Ulun Crimizade, Philippe Reydel, Laurent Tritsch and Patrick Ohlmann - Eur Heart J Acute Cardiovasc Care Mar;6(2):
Floriane Zeyons, MD
University Hospital of Strasbourg, France

2. Introduction
Out of hospital cardiac arrest (OHCA)
High mortality : 90% of all OHCA, 75% when admitted alive to the hospital
Cardiac origin : 70%, mainly acute myocardial infarction (AMI)
Acute myocardial infarction (AMI):
Better outcome with emergency angioplasty, the sooner the better
The usual clinical and electrical signs may be absent
=> So, should all OHCA cases be immediately referred to the cath lab ?

3. Introduction Problem for the patient: Problem for other patients :
Unnecessary procedure , potentially harmful
Can delay some of the treatment, or other exams
Problem for other patients :
Risk of congesting the cath lab

4. Methods Retrospective, single center study
Consecutive survivors of OHCA referred to the cath lab between and 2013
Analysis :
Initial ECG from the SMUR unit (mobile emergency medical system)
In hospital medical and biological findings
Results of the coronary angiogramm
3 groups of patients :
Group 1 : AMI related OHCA
Groupe 2 : Chronic CAD related OHCA
Group 3 : Non CAD related OHCA
Objective : To identify predictors of AMI among survivors of OHCA

5. General results 177 patients included
Group1 : 76 (43%) – Group 2 : 27 (15%) – Group 3 : 74 (42%)
PCI : 95 (54%)
Group 1 : 95%
Group 2 : 67%
Group 3: 8%
Survival rate 33%
Group 1: 41%
Group 2 : 44%
Group 3 : 22%

6. Results : clinical characteristics

7. Results : ECG findings

8. Results : predictors of AMI

9. Results : AMI diagnostic score
Item
Number of points
Chest pain before the arrest 1
Shockable initial rhythm
ST-segment elevation in any lead (including aVR) 2
>0
>1
>2
>3

10. Discussion 1
The rate of AMI (43%) and CAD (73%) in our population is coherent with other studies
Only 54% of the patients received PCI
Group 3 : Although in the end CAD was not the cause of the arrest, 8% had PCI => excessive treatment ?

11. Discussion 2
Using an extended definition of ST elevation to include lead aVR increases the sensitivity
Added values of using the score:
A) To rule out AMI :
Score of 0 : low probability of AMI => ICU first, echocardiography, biology, etc…
B) To better appreciate the likelihood of AMI
High score=> insist on coronary angiogram before anything else.
2015 ESC guidelines : OHCA patients without a clear STEMI or ACS => short stop in the ICU/emergency room to rule out other causes of cardiac arrest

12. Discussion 3 Limitations of the study : Retrospective
Coronary angiogramm registry
Single center
Limited number of patient

13. Take home messages AMI in only 43% of cases
Look for ST elevation in aVR
The diagnostic score integrating chest pain before the arrest, a shockable initial rhythm, and ST elevation in any lead helps evaluate the likelihood of AMI
With a score of 0, AMI is highly unlikely
A stop to the ICU before rushing in the cath lab might be a valid strategy for those patients.
Results need to be confirmed in a large-scale prospective study