Out of Hospital Cardiac Arrest Without ST-segment Elevation
Conditions
Keywords
Cardiac arrest, Diagnostic accuracy, Coronary computarized tomography angiogram, Coronary Calcium Score, Non-ST Elevated Myocardial Infarction
Brief summary
Out-of-hospital cardiac arrest (OHCA) has multiple etiologies. In the absence of ST-elevation myocardial infarction, percutaneous coronary intervention (PCI) is delayed. This study aims to determine the diagnostic accuracy of Coronary Calcium Score (CCS) and Coronary CT Angiogram (CCTA) to rule out a coronary artery disease (CAD) in the first days after an OHCA.
Detailed description
Each year, 50.000 out-of-hospital cardiac arrest (OHCA) occur in France. Acute myocardial infarction (AMI) is one of the most frequent etiology of OHCA. When a cardiac arrest is due to a ST-elevation myocardial infarction (STEMI), a percutaneous coronary intervention (PCI) is realized in emergency. However, without ST-elevation, PCI timing is unclear. 2020 European Society Recommandations suggest that PCI should not be realized in emergency, based on Lemkes and al. clinical trial. But there is scarce evidence about the exact timing to realize PCI. Electrocardiogram, troponin level, and echocardiography are unprecise to rule-out an ischemic etiology of cardiac arrest. A brain CT-scan and a CT-pulmonary angiogram are recommended in first place, to identify the etiology of the cardiac arrest if there is no ST-elevation nor obvious causes. Nevertheless, in the absence of scanographic abnormality, a differed coronary angiogram should be realized. We suggest that coronary CT angiogram (CCTA) and coronary calcium score (CCS) are feasible in the first days of hospitalization, and could rule-out a coronary artery disease (CAD). The aim of the study is to avoid an invasive coronary exploration, and to have a quick answer about anti-thrombotic treatments management.
Interventions
OTHERCoronary Calcium Score and Coronary CT angiogram
Introduction of early Coronary CT angiogram and Coronary Calcium Score in the first days after a resuscitated out-of-hospital cardiac arrest.
Sponsors
CHU de Reims
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
: * Patients hospitalized in intensive care unit after a resuscitated out-of-hospital cardiac arrest * No obvious cause for sudden death on anamnestic information, CT brain and CT pulmonary angiogram. * Absence of ST elevation myocardial infarction Non-inclusion criteria : * In-hospital cardiac arrest * Refractory cardiac arrest * Indication of immediate coronary angiography * ST-elevation myocardial infarction or unknown left bundle branch block * Dynamic or presumably new contiguous ST/T-segment changes * Cardiogenic shock * Life-threatening arrhythmias * Coronary artery bypass graft * Pregnancy * Multiple organ failure syndrome * Know severe chronic kidney disease (GFR \<30mL/min/1,73m²)
Exclusion criteria
: * During the Coronary computerized tomographic angiogram : * Haemodynamic instability requiring high dose of vasopressors (\>1µg/kg/min of Norepinephrine) * Non sinusal cardiac rhythm * KDIGO 1 Acute kidney injury
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Diagnostic accuracy of Coronary Computerized Tomographic Angiogram to rule-out a coronary stenosis > 50% | During hospitalization (maximum 7 days from ICU admission) |
Secondary
| Measure | Time frame |
|---|---|
| Cororany calcium score associated with coronary stenosis between 50% and 70% | During hospitalization (maximum 7 days from ICU admission) |
| Diagnostic accuracy of Coronary Computerized Tomographic Angiogram associated with Coronary Calcium Score compared to CCTA performance alone | During hospitalization (maximum 7 days from ICU admission) |
| Diagnostic accuracy of Coronary Computerized Tomographic Angiogram to rule-out a coronary stenosis > 70% | During hospitalization (maximum 7 days from ICU admission) |
| Comparison of contrast volume between CCTA and percutaneous coronary intervention | During hospitalization (maximum 7 days from ICU admission) |
| Comparison of radiation dose between CCTA and percutaneous coronary intervention | During hospitalization (maximum 7 days from ICU admission) |
| Incidence of contrast associated acute kidney injury | Day 15 |
Countries
France
Contacts
Primary ContactAntoine GOURY
Backup ContactBruno MOURVILLIER
Outcome results
None listed