Post resuscitation electrocardiogram for coronary angiography indication after out-of-hospital cardiac arrest.

BACKGROUND: Coronary angiography is the standard of care after Out-of-Hospital Cardiac Arrest (OHCA), but its benefit for patients without persistent ST-segment elevation (STE) remains controversial. METHODS: All patients admitted for coronary angiography after a resuscitated OHCA were consecutively included in this prospective study. Three patient groups were defined according to post-resuscitation ECG: STE or new left bundle branch block (LBBB) (group 1); other ST/T repolarization disorders (group 2) and no repolarisation disorders (group 3). The proportion and predictive factors of an acute coronary lesion, defined by acute coronary occlusion or thrombotic lesion or lesion associated with flow impairment, were evaluated according to different groups as well as thirty-day mortality. RESULTS: Among 129 consecutive patients: 62 (48.1%), 30 (23.3%) and 30 (23.3%) patients were included in groups 1, 2 and 3 respectively. An acute coronary lesion was observed in 43% (n = 55) of patients, mainly in group 1 (n = 44, 70.9%). Initial coronary TIMI 0/1 flow was more frequently observed in group 1 than in group 2 (n = 25, 40.3% vs n = 1, 3.3%) and never in group 3. Chest pain and STE or new LBBB were independently associated with an acute coronary lesion (adj. OR = 7.14 [1.85-25.00]; p = 0.004 and adj. OR = 11.10 [3.70-33.33]; p < 0.001 respectively). In absence of any repolarization disorders, acute coronary lesion or occlusion were excluded with negative predictive values of 93.3% and 100% respectively. The one-month survival rate was 38.8% and was better in patients among the group 1 compared to those from the 2 other groups (n = 28, 45.2% vs n = 21, 35%, respectively; p = 0.014). CONCLUSION: Considering the high negative predictive value of post-resuscitation ECG to exclude acute coronary lesion and occlusion after OHCA, a delayed coronary angiography appears a reliable alternative for patients without repolarization disorders.

[Severe bleeding with antiplatelet therapy: What to do?] / Accidents hémorragiques graves sous antiplaquettaires : que faire ?

Antiplatelet therapy is the cornerstone of coronary artery disease treatment and prevention. Combination of aspirin and P2Y12 inhibitor is recommended after acute coronary syndrome and after elective percutaneous coronary intervention. The optimal duration of dual antiplatelet therapy depends on the individual ischemic and bleeding risk of the patient. Bleeding on dual anti platelet therapy remains the most frequent complication of antiplatelet therapy even is mostly minimal or moderate. Beyond individualized evaluation of patients' bleeding risk, management of patients with severe bleeding complications is a challenging situation and requires general and specific recommendations with interruption of the dual antiplatelet therapy in the vast majority of the cases.