In a significant portion of patients surviving a cardiac arrest, the event is caused by a myocardial infarction (a narrowing or blockage of one or more blood vessels that supply blood to the heart, the coronary arteries). In some people, this is immediately evident from basic tests; in others, it is more difficult to predict with the currently available tests whether this (or something else) caused the cardiac arrest. We investigate a technique that allows us to also assess the coronary arteries on the CT scan that is performed in patients surviving a cardiac arrest. The coronary angiography is currently the best exam we have for examining the coronary arteries, but it has some disadvantages. Compared to the CT scan, it takes more time, needs a more complex access to the blood vessels, and has some rare but relevant possible complications. The major advantage of the coronary angiography is that there is the possibility of immediate treatment of a narrowed/blocked blood vessel of the heart. The current guidelines advice an urgent coronary angiography when a clear myocardial infarction is suggested on the electrocardiogram, but not when there is no clear indication of myocardial infarction. Nonetheless, a relevant portion (more or less 40%) of the patients without a clearly abnormal electrocardiogram, still have an important problem in the blood vessels of the heart. We aim to determine whether the CT scan provides accurate information about the condition of the blood vessels of the heart. The CT scan was already well examined for this purpose before, but in the currently conventional way it needs preparation with extra monitoring and administration of medication, which would lead to loss of precious time and potentially dangerous side effects of these drugs in this critical situation. For that reason, a new software modality was developed that allows us to examine the coronary arteries in the same CT scan, without need for additional monitoring or medication administration. It does not need additional contrast administration (the dye necessary for optimal evaluation of some diseases).
The goal of this study is to determine whether this new technique gives us the correct information about the coronary arteries. This means we acquire the images of the heart in the same scan, and verify the results with the conventional coronary angiography. If the technique provides accurate information, it could lead to a better selection of patients we need to urgently refer for a coronary angiography and to defer the exam in those who have normal coronary arteries on the scan.
Adults (≥18 years) with sustained return of spontaneous circulation (ROSC) following in/out-of-hospital cardiac arrest.
Informed consent from patient or representative obtained before invasive coronary angiography.
Exclusion
Patients on VA-ECMO
None
Single group
ECG-less gated cardiac CT
DevicePerform ECG-less gated cardiac CT during the CT scan routinely executed after survival of cardiac arrest in patients without STEMI.
Percentage of patients correctly classified to coronary artery disease as the cause of cardiac arrest after analysis of the CT scan
With the invasive coronary angiography as a gold standard, the investigator will assess whether the CT scan correctly allocated the patient to coronary versus non coronary cause of cardiac arrest
Level of agreement on the estimated percentage of coronary artery stenosis between CCTA and ICA
The degree of coronary stenosis will be estimated per-vessel (left main coronary artery, left anterior descendens, left circumflex artery and right coronary artery). The results will be reported as categorical variables: \< 25%, 25-50%, 51-70%, 71-90%, \>90% or insufficient image quality.
Feasibility of ECG-less gated CCTA in resuscitated patients
Percentage of patients where data on coronary stenosis based on ECG-less CCTA cannot be provided or is incompletely provided.
Reasons for failure of ECG-less gated CCTA image acquisition
Registrations of reasons for failure of complete CCTA reporting (eg incorrect timing, tachycardia/irregular heart rhythm...)
Survival
Survival status assessed by analysis of the electronic medical record
Click on the lead sponsor to view all of their trials.
