Coronary artery disease (CAD) is the leading cause of OHCA. However, diagnosis of ACI remains challenging, particularly in patients without ST-segment elevation on the post-resuscitation ECG. In this regard, a consensus statement recommends the implementation of a work-up strategy in the emergency room (ER) to exclude non-coronary causes of collapse within 2hours.

We present data on coronary angiograms for patients who underwent cardiac catheterization after resuscitation. Afterwards, we sought to identify parameters associated with ACI.

Retrospective single-centre study performed on 64 consecutive patients with resuscitated OHCA who underwent a diagnostic coronary angiography (CA). Data collection was performed from the patient records at the ER and the catheterization laboratory. ST-segment elevation was noted in 29 patients (45%). ST-segment depression or T-wave abnormalities were noted in 35 patients (55%).

Invasive coronary strategy allowed to identify an acute culprit lesion in 46 cases (72%). 29 patients with ST-segment elevation underwent an immediate angioplasty for an acute coronary occlusion. 17 patients without ST-segment elevation underwent an ad hoc percutaneous coronary intervention for a critical lesion. Stable CAD was found in 9 cases (14%) and a normal angiogram was found in only 9 cases (14%) (Fig. 1). The independent predictors of ACI were convertible rhythm (OR 16.02; 95% CI 4.48–57.29), personal history of CAD (OR 15.12; 95% CI 4.19–54.53) and presence of at least 2 cardiovascular risk factors (OR 10.68; 95% CI 2.55–44.74) (Table 1).

ACI was the leading precipitant of collapse. ST-segment elevation was highly predictive of coronary occlusion. A culprit coronary lesion was identified in nearly 50% of patients undergoing CA despite the lack of ST-segment elevation. Our findings also suggest that the identification of risk criteria may help to improve the recognition of ACI after OHCA.