Role of Neuroimaging Before Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest.

BACKGROUND

Patients presenting following out-of-hospital cardiac arrest (OOHCA) often require emergency coronary angiography. Presentations can be associated with syncope or head-trauma.

AIMS: We investigated the impact and utility of pre-coronary angiography CT-Brain (CT-B) in patients following OOHCA on clinical outcomes.

METHODS

Retrospective analysis was undertaken at a large metropolitan hospital to identify patients. Patients following OOHCA who were transferred directly to the cardiac catheterization lab were included with patients stratified according to whether they received a CT-B prior to coronary angiography or not.

RESULTS

Following analysis, 235 patients met inclusion criteria. The CT-B (n = 39) and non-CT-B (n = 196) groups were similar in baseline demographics with respect to age (64.1 vs. 63.3 years, p = 0.739), male sex (79.2% vs. 82.7%, p = 0.637), hypertension (48.7% vs. 49.2%, p = 0.953), and hypercholesterolemia (33.3% vs. 32.8%, p = 0.950) respectively. There was no difference in ECGs suggestive of cardiac ischemia (53.8% vs. 61.7%, p = 0.338). The CT-B group were more likely to have fallen (89.7% vs. 50.5%, p < 0.001), and have documented head strike (61.5% vs. 8.2%, p < 0.001). Door-to-procedure time was significantly longer in the CT-B group (105 vs. 53 min, p < 0.001). There was no difference in length of ICU stay (median 3 (IQR 1-6) vs. 3-days (IQR 1-6), p = 0.44), or 30-day mortality (41.0% vs. 29.5%, p = 0.159). Of those undergoing CT-B, 17.9% had pathology identified, with only one patient (2.6%) having their angiogram deferred.

CONCLUSION

In patients with OOHCA, pre-angiography CT-B has a low likelihood of identifying neuropathology and significantly increases DTP time.