- Oral presentation
- Open Access
Out of hospital cardiac arrest survivors with inconclusive coronary angiogram: impact of cardiovascular magnetic resonance on clinical management and decision-making
© Baritussio et al. 2016
- Published: 27 January 2016
- Cardiovascular Magnetic Resonance
- Cardiac Magnetic Resonance
- Clinical Impact
- Primary Percutaneous Coronary Intervention
- Myocardial Revascularization
Non-traumatic out of hospital cardiac arrest (OHCA) is the leading cause of death worldwide, acute coronary syndromes accounting for up to 2/3 of cases. Urgent angiography with a view to primary percutaneous coronary intervention (PPCI) is a class IB recommendation according to international guidelines. Diagnosis and management of patients with unobstructed coronaries or unidentified culprit lesion on angiogram is challenging. Cardiac magnetic resonance (CMR) with its superior tissue characterization is a well-established diagnostic technique. We sought to assess the additive role of CMR in diagnosis and management of patients with an inconclusive coronary angiogram and to determine which findings on CMR best predict clinical impact.
We retrospectively analysed our database to collect data on consecutive patients surviving non-traumatic OHCA, undergoing urgent coronary angiogram and CMR. We focused the analysis on patients with an inconclusive angiogram, defined as the evidence of unobstructed coronaries or of coronary artery disease (CAD) without a clear culprit lesion. Clinical impact of CMR was defined as a change in diagnosis, as compared to that made on a multi-parametric pre-CMR basis (clinical history, electrocardiogram, trans-thoracic echocardiogram), or a change in management, which could be a change in medication or the performance/avoidance of invasive procedures (repeat angiogram, myocardial revascularization, ICD implantation).
Predictors of clinical impact
95% CI for EXP (B)
Impact of STIR
CMR had an additive clinical impact on diagnosis and management in 65% of patients surviving OHCA with an inconclusive coronary angiogram. LGE and segmental regional wall motion abnormality were the best independent predictors of clinical impact following CMR. CMR should be enclosed in the clinical-diagnostic work-up of this subgroup of OHCA survivors.
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