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Implications of Alternative Definitions of Peri-Procedural Myocardial Infarction After Coronary Revascularization Transition of Macrophages to Fibroblast-Like Cells in Healing Myocardial Infarction Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome SCAI clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019 Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction Considerations for Single-Measurement Risk-Stratification Strategies for Myocardial Infarction Using Cardiac Troponin Assays No causal effects of plasma homocysteine levels on the risk of coronary heart disease or acute myocardial infarction: A Mendelian randomization study Open sesame technique in percutaneous coronary intervention for ST-elevation myocardial infarction Complete Versus Culprit-Only Lesion Intervention in Patients With Acute Coronary Syndromes Optimal Timing of Intervention in NSTE-ACS Without Pre-Treatment The EARLY Randomized Trial

Review ArticleVolume 12, Issue 8, April 2019

JOURNAL:JACC Cardiovasc Interv. Article Link

Utility and Challenges of an Early Invasive Strategy in Patients Resuscitated From Out-of-Hospital Cardiac Arrest

JC Jentzer, J Herrmann, A Prasad et al. Keywords: coronary angiography; coronary artery disease; myocardial infarction; percutaneous coronary intervention; revascularization

ABSTRACT

Out-of-hospital cardiac arrest (OHCA) is frequently triggered by acute myocardial ischemia. Coronary angiography is an important component of post-resuscitation care for patients with OHCA without an evident noncardiac cause, to identify underlying coronary artery disease and allow revascularization. Most patients undergoing coronary angiography after OHCA have obstructive coronary artery disease, and nearly one-half of patients have acute coronary occlusion. Early coronary angiography and percutaneous coronary intervention after OHCA have been associated with improved survival in observational studies, but these studies demonstrate selection bias, and randomized trials are lacking. Selection of patients for coronary angiography after OHCA can be challenging, particularly in comatose patients whose outcomes are driven primarily by anoxic brain injury. As for other patients with acute coronary syndromes, patients with ST-segment elevation after OHCA have a high probability of acute coronary occlusion warranting emergent coronary angiography. Patients with cardiogenic shock after OHCA are a high-risk population also requiring emergent coronary angiography. Among patients in stable condition after OHCA without ST-segment elevation, other clinical predictors can be used to identify those needing early coronary angiography to identify obstructive coronary artery disease. Despite the challenges with early neurological prognostication in comatose patients with OHCA, those with multiple objective markers of poor prognosis appear less likely to benefit from revascularization, and early coronary angiography may be reasonably deferred in appropriately selected patients meeting these criteria. The authors propose an algorithm to guide patient selection for coronary angiography after OHCA that combines clinical predictors of acute coronary occlusion and early clinical predictors of severe brain injury.