Early Coronary Angiography for Survivors of Out-of-Hospital Cardiac Arrests Without ST Elevation

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There are over 300,000 out-of-hospital cardiac arrests (OOHCA) in the United States each year, and the long-term survival rate is less than 10%. Despite improvements in postarrest management, the greatest drop-off in survival occurs during hospitalization, mostly due to myocardial dysfunction and neurological injury. Coronary artery disease is common in postcardiac arrest patients, with an incidence of approximately 60–80%. In patients with a chest pain syndrome and an ST-segment–elevation myocardial infarction pattern evident on the presenting electrocardiogram, immediate revascularization is recommended by cardiovascular societies due to established mortality benefits. However, it is less clear whether immediate or urgent coronary angiography for OOHCA survivors without ST elevation on the presenting electrocardiogram is beneficial. The current evidence base suggests that many OOHCA survivors, particularly when an acute coronary event is suspected, stand to benefit from early coronary angiography, although prospective trial data are lacking. Further studies are needed to identify whether all or even a subset of OOHCA survivors without ST elevation should undergo routine early coronary angiography.

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