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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Saturday, December 17, 2016

ROSC but No ST-Segment Elevation

R.E.B.E:L.EM - By Salim rezaie - December 15, 2016
"Background: The American Heart Association/American College of Cardiology (AHA/ACC) give a Class I recommendation for activation of the cardiac catheterization lab in patients with out-of-hospital cardiac arrest (OHCA) whom ST-segment elevation myocardial infarction (STEMI) is present. The evidence for early cardiac catheterization in patients after cardiac arrest, with ROSC and no STEMI is a bit more controversial. The most recent 2015 AHA/ACC guidelines recommend, “it may be reasonable,” to perform an emergent cardiac catheterization in select patients without STEMI.
What They Did: 
Systematic review and meta-analysis of post-cardiac arrest patients without STEMI taken to cardiac catheterization lab
Author Conclusion: “The results of this systematic review demonstrate that nearly one third of patients who have been successfully resuscitated from cardiopulmonary arrest without ST elevation on ECG have an acute lesion that would benefit from emergent percutaneous coronary intervention.”
Clinical Take Home Point: 1/3 of post OHCA patients without STEMI were found to have a “culprit lesion” causing an acute MI that could potentially benefit from PCI. This study should help start communication with cardiology at your institution to start setting up system wide guidelines of which patients with OHCA, ROSC, and no STEMI on ECG would benefit from emergent cardiac catheterization. Not all patients may benefit from emergent cardiac catheterization, but lack of STEMI on ECG post ROSC does not mean your patient doesn’t have a culprit lesion causing their cardiac arrest"