Acute Coronary Occlusion in Patients With Non-ST-Segment Elevation Out-of-Hospital Cardiac Arrest.

Spirito, Alessandro; Vaisnora, Lukas; Papadis, Athanasios; Iacovelli, Fortunato; Sardu, Celestino; Selberg, Alexandra; Bär, Sarah; Kavaliauskaite, Raminta; Temperli, Fabrice; Asatryan, Babken; Pilgrim, Thomas; Hunziker, Lukas; Heg, Dik; Valgimigli, Marco; Windecker, Stephan; Räber, Lorenz (2023). Acute Coronary Occlusion in Patients With Non-ST-Segment Elevation Out-of-Hospital Cardiac Arrest. Journal of the American College of Cardiology, 81(5), pp. 446-456. Elsevier 10.1016/j.jacc.2022.10.039

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According to current guidelines, hemodynamic status should guide the decision between immediate and delayed coronary angiography (CAG) in out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation. A delayed strategy is advised in hemodynamically stable patients, and an immediate approach is recommended in unstable patients.


This study sought to assess the frequency, predictors, and clinical impact of acute coronary occlusion in hemodynamically stable and unstable OHCA patients without ST-segment elevation.


Consecutive unconscious OHCA patients without ST-segment elevation who were undergoing CAG at Bern University Hospital (Bern, Switzerland) between 2011 and 2019 were included. Frequency and predictors of acute coronary artery occlusions and their impact on all-cause and cardiovascular mortality at 1 year were assessed.


Among the 386 patients, 169 (43.8%) were hemodynamically stable. Acute coronary occlusions were found in 19.5% of stable and 24.0% of unstable OHCA patients (P = 0.407), and the presence of these occlusions was predicted by initial chest pain and shockable rhythm, but not by hemodynamic status. Acute coronary occlusion was associated with an increased risk of cardiovascular death (adjusted HR: 2.74; 95% CI: 1.22-6.15) but not of all-cause death (adjusted HR: 0.72; 95% CI: 0.44-1.18). Hemodynamic instability was not predictive of fatal outcomes.


Acute coronary artery occlusions were found in 1 in 5 OHCA patients without ST-segment elevation. The frequency of these occlusions did not differ between stable and unstable patients, and the occlusions were associated with a higher risk of cardiovascular death. In OHCA patients without ST-segment elevation, chest pain or shockable rhythm rather than hemodynamic status identifies patients with acute coronary occlusion.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Spirito, Alessandro, Vaisnora, Lukas, Papadis, Athanasios, Bär, Sarah, Kavaliauskaite, Raminta, Temperli, Fabrice Gil, Asatryan, Babken, Pilgrim, Thomas, Hunziker Munsch, Lukas Christoph, Heg, Dierik Hans, Windecker, Stephan, Räber, Lorenz


600 Technology > 610 Medicine & health






[4] Swiss National Science Foundation




Pubmed Import

Date Deposited:

02 Feb 2023 10:16

Last Modified:

20 Feb 2024 14:15

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Uncontrolled Keywords:

coronary angiography coronary occlusion death non–ST-segment elevation out-of-hospital cardiac arrest




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