Patients who are comatose after cardiac arrest continue to be a challenge, with high mortality. Although there is an American College of Cardiology Foundation/American Heart Association Class I recommendation for performing immediate angiography and percutaneous coronary intervention (when indicated) in patients with ST-segment elevation myocardial infarction, no guidelines exist for patients without ST-segment elevation. Early introduction of mild therapeutic hypothermia is an established treatment goal. However, there are no established guidelines for risk stratification of patients for cardiac catheterization and possible percutaneous coronary intervention, particularly in patients who have unfavorable clinical features in whom procedures may be futile and affect public reporting of mortality. An algorithm is presented to improve the risk stratification of these severely ill patients with an emphasis on consultation and evaluation of patients prior to activation of the cardiac catheterization laboratory.
Bibliographical noteFunding Information:
The views expressed in this paper by the American College of Cardiology’s (ACC’s) Interventional Council do not necessarily reflect the views of the Journal of the American College of Cardiology or the ACC. Dr. Kern has served as a science advisory board member for Zoll Medical and PhysioControl Inc.; and has served on the speakers bureau for C.R. Bard. Dr. McDaniel is a consultant for Medicure. Dr. Dickert has received grant funding from the Patient-Centered Outcomes Research Institute and the Greenwall Foundation . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- cardiac catheterization
- out-of-hospital cardiac arrest
- percutaneous coronary intervention
- risk stratification