Patients presenting with out of hospital cardiac arrest (OHCA) and no evidence of extra-cardiac cause have a poor short term outcome. This study sought to identify which post-cardiac arrest patients may or may not benefit from emergency coronary angiography (ECA) and primary percutaneous coronary intervention (PCI).

Observational study in consecutive patients treated for OHCA from 2006 to 2012. Retrospective analysis of clinical, electrocardiographic, and angiographic factors associated with usefulness of PCI and in-hospital survival.

Between 2006 and 2012, 121 consecutive pts surviving OHCA with no evidence of extra-cardiac cause were admitted in our centre and underwent ECA (median age 61 years, 85% males). Mild hypothermia was used in 105 (87%) of the pts. Survival at hospital discharge was 41%. Prehospital defibrillation with AED was used in 92 (76%) of pts, and was associated with a decrease in hospital mortality (49% vs 90%; p<.0001). In the group of pts who received at least one AED shock, survival rates considerably varied according to the first rhythm registered on 12-lead ECG: 74% (35/47) in case of Sinus Rhythm or Atrial Fibrillation, 43% (12/28) in case of persistent Ventricular Tachycardia or Fibrillation, and 0% (0/17) in case of secondary asystole (p<.0001) (Figure).

ECA and/or PCI should be restricted to OHCA survivors without either primary asytole (no AED shock) or secondary asystole (after at least 1 AED shock), although the prevalence of significant coronary disease is high in this latter subgroup.