Abstract 13434: Chronic Total Occlusions in Refractory Cardiac Arrest Patients

• Published in: Circulation (New York, N.Y.) N.Y.), 2021-11, Vol.144 (Suppl_2), p.A13434-A13434
• Main Authors: Kral, Ales, Belohlavek, Jan, Rob, Daniel, Smalcova, Jana
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.144.suppl_2.13434

IntroductionCoronary artery disease (CAD) is the most frequent cause of cardiac arrest (CA) in adults. Coronary chronic total occlusions (CTOs) are associated with an increased risk CA and predict future malignant arrhythmias in CA survivors. Nevertheless, the prevalence of CTOs in patients with CA and especially refractory CA is poorly characterized. We sought to evaluate the frequency and characteristics of CTOs in refractory CA patients included in the Prague-OHCA study. MethodsFrom 256 patients with refractory CA randomized in the Prague-OHCA study, coronary angiography (CAG) was performed in 181 subjects. Of the 128 patients with significant CAD (defined as more than 50% diameter stenosis in at least one major coronary vessel), 14 had a different primary cause of CA, leading to a study cohort of 114 patients with CAD as the primary cause of CA. 41 patients had at least one coronary CTO, whereas 73 patients had significant CAD without CTOs. Clinical, angiographic parameters, initial management and outcome was compared between the CTO and non-CTO groups. ResultsPatients in the CTO cohort were older (59 ±12 versus 54 ±11 years, p = 0.015) and had shorter CA durations (45 ± 25 versus 55 ± 24 minutes, p = 0.03) as compared to patients in the non-CTO cohort. The CTO cohort presented less frequently with an acute coronary syndrome (ACS) (51 versus 89%, p < 0.0001) and had a higher prevalence of multi-vessel disease (89 versus 51%, p < 0.0001), as compared to the non-CTO cohort. Acute index PCI was performed less frequently in the CTO group (61 versus 86%, p = 0.002). Patients in the CTO group experienced more frequent neurologic recovery (51 versus 32%, p = 0.04), whereas cardiac recovery (63 versus 51%, p = 0.19) and six month mortality (51 versus 59%, p = 0.43) did not differ between the CTO and non-CTO group. ConclusionsCTOs represent a frequent cause of refractory CA. Patients with refractory CA due to CTOs were older with a high prevalence of multi-vessel disease and presented less frequently with an ACS, as compared to patients with significant CAD without CTOs. The observed more frequent neurologic recovery in the CTO cohort is presumably due to shorter CA durations in these patients. Mid- and long-term prognosis did not differ between the CTO and non-CTO cohort.