Impact of Resuscitation Status and Cardiac Arrest Location on Survival and Neurological Outcomes in Acute Coronary Syndrome Patients Undergoing Coronary Angiography.

Background

Cardiac arrest complicating acute coronary syndrome (ACS) is associated with high mortality and neurological morbidity despite advances in percutaneous coronary intervention (PCI) and post-resuscitation care. This study evaluated clinical outcomes in ACS patients presenting with cardiac arrest undergoing invasive coronary angiography, with particular focus on resuscitation status before catheterization and location of cardiac arrest.

Methods

A retrospective analysis of 15,595 ACS patients undergoing coronary angiography between 2014 and 2025 identified two cohorts. The first cohort included 131 patients stratified according to mechanical cardiac activity upon arrival to the catheterization laboratory: previously resuscitated patients (RES, n = 109) and patients in refractory cardiac arrest requiring automatic resuscitation devices (ARD, n = 22). The second cohort included 159 patients grouped by arrest location: out-of-hospital (OHCA, n = 83), in-hospital (IHCA, n = 48), and catheterization laboratory cardiac arrest (CLCA, n = 28). The primary outcomes were in-hospital mortality and neurological status after resuscitation.

Results

In-hospital mortality was significantly higher in the ARD group compared with the RES group (86.4% vs. 39.4%, p < 0.001). Survivors in the RES group more frequently achieved favorable neurological recovery (66.2%). Mean resuscitation duration and admission lactate levels were significantly greater in the ARD group (66.1 vs. 21.9 min, p < 0.001; 10.7 vs. 7.7 mmol/L, p = 0.006). According to arrest location, mortality was highest in the CLCA group (78.6%), followed by IHCA (60.4%) and OHCA (39.8%) (p < 0.001). Despite high mortality, all surviving CLCA patients had favorable neurological outcomes. Culprit coronary vessel distribution was not associated with mortality or neurological outcome.

Conclusions

In ACS patients with cardiac arrest, ongoing refractory arrest during coronary angiography and cardiac arrest occurring in the catheterization laboratory were associated with markedly increased mortality. Successful resuscitation prior to catheterization was associated with significantly better survival and neurological recovery.