Coronary angiography may improve outcomes for cardiac arrest patients

April 01, 2009

People who suffer cardiac arrests and then receive coronary angiography are twice as likely to survive without significant brain damage compared with those who don't have the procedure, according to a study by University of Pittsburgh School of Medicine researchers. The study, published in the May/June issue of the Journal of Intensive Care Medicine and now available online, showed that patient outcomes improved with coronary angiography, an imaging procedure that shows how blood flows through the heart, regardless of certain clinical and demographic factors that influenced who received the procedure.

"Given the low odds of survival - about 6 percent - for patients who suffer out-of-hospital cardiac arrests, it's important to understand which treatments might make a difference in these dismal outcomes," noted Jon C. Rittenberger, M.D., corresponding author of the study and an assistant professor in the Department of Emergency Medicine at the University of Pittsburgh. The importance of prompt coronary angiography is well-established for cardiac arrest patients presenting with certain types of heart problems, Dr. Rittenberger noted. "But our study, which shows that angiography is independently associated with good neurologic outcomes, suggests that clinicians should consider the procedure for all post-cardiac arrest patients," he added.

Coronary angiography uses a contrast dye and X-rays to see the blood vessels and chambers of the heart. The procedure is usually done in conjunction with catheterization, which involves threading a thin hollow tube through an artery and into the heart. Dye is injected into the catheter and highlights any blockages in blood flow, which are then visible by X-ray.

The researchers retrospectively analyzed the charts of 241 adult cardiac arrest patients who were treated at UPMC Presbyterian Hospital, part of the University of Pittsburgh Medical Center, between January 1, 2005, and December 31, 2007. Coronary artery disease was present in 52 percent of the patients, and the rate did not differ between those who received coronary angiography (40 percent of the group) and those who did not. Those findings are consistent with prior research showing that 60 to 80 percent of cardiac arrests are a result of cardiovascular disease.

Just over half of patients who received coronary angiography experienced a good clinical outcome - defined as being discharged to home or to an acute rehabilitation facility - compared to 24.8 percent of patients who do not have the procedure. Early angiography, performed within 24 hours of a patient's arrival, was not associated with improved survival when compared to having the procedure done later, but researchers noted that the small number of patients may have made it impossible to prove a difference.

"Coronary angiography appears to put patients on a more proactive path of care, which may lead to a better outcome," said Dr. Rittenberger. "As this study demonstrates, most of these cardiac arrest patients have heart disease, which is often something that we can fix. Many of the patients who get coronary angiography go on to get bypass surgery, a balloon pump, a defibrillator or other such aggressive treatments."

Rittenberger and his colleagues found no significant differences between those who received angiography and those who did not with respect to age, history of cardiac disease and use of therapeutic hypothermia, a procedure used to cool patients who remain comatose after resuscitation following cardiac arrest to prevent brain damage. However, patient sex, location of the arrest, the initial heart rhythm disturbance and certain coronary and neurologic abnormalities were among the predictors of who would receive angiography. Men who suffered cardiac arrests outside of the hospital were more likely to have the procedure. The researchers also found that coronary angiography was more likely to be performed on patients with better neurological status. However, with the use of therapeutic hypothermia, patients may not reveal their true neurological state for several days after the return of spontaneous blood circulation, they noted.

University of Pittsburgh Schools of the Health Sciences

---

---

	Diagnostic Cerebral Angiography by Anne G. Osborn (Author) Since 1980, Dr. Osborn's An Introduction to Cerebral Angiography has been the definitive text on this imaging modality. Now, this classic work has been completely revised, reorganized, and updated and expanded from an introductory book into a comprehensive, state-of-the-art reference on cerebral angiography.Diagnostic Cerebral Angiography, Second Edition, is organized into three major parts. Part 1 covers techniques and technical aspects of cerebral angiography. Part 2 is a detailed description of normal anatomy, anatomic variations, and congenital anomalies. Part 3 focuses on pathological entities, including trauma, aneurysms, stroke, vascular malformations, atherosclerosis, and vasculitis.Coverage includes new information on vascular territories, film subtraction, and magnetic resonance...
	CT and MR Angiography: Comprehensive Vascular Assessment by Geoffrey D. Rubin (Editor), Neil M. Rofsky (Editor) Written by world-renowned experts in both CT angiography and MR angiography, this landmark work is the first comprehensive text on vascular imaging using CT and MR. It provides a balanced view of the capabilities of these modalities and practical guidelines for obtaining and interpreting images. More than 2,200 illustrations complement the text. Chapters co-authored by CT and MR authorities cover imaging of all coronary and non-coronary arteries and veins. Each chapter details indications, imaging strategies, normal and variant anatomy, diseases, surgical management, and pitfalls. The authors compare the utility of CT and MR in specific clinical situations and discuss the role of conventional angiography and ultrasound where appropriate.
	Abrams' Angiography: Interventional Radiology by Stanley Baum (Editor), Michael J. Pentecost (Editor) The Interventional Radiology volume of the landmark reference Abrams' Angiography has now been expanded and thoroughly revised to reflect dynamic advances in interventional radiology. More than 60 contributors representing a "Who's Who" of the specialty provide comprehensive, step-by-step coverage of all contemporary vascular and nonvascular interventional procedures. Major sections discuss today's equipment and describe interventions for specific disorders of each organ system, as well as for trauma, pediatric diseases, abscess drainage, and miscellaneous disorders. Fifteen new chapters cover cutting-edge innovations, including stent-grafts, radiofrequency ablation, CT angiography, MR angiography, uterine fibroid embolization, and vertebroplasty. More than 1,100 illustrations complement...
	MR Angiography of the Body: Technique and Clinical Applications (Medical Radiology / Diagnostic Imaging) by Emanuele Neri (Editor), Mirco Cosottini (Editor), Davide Caramella (Editor) Magnetic resonance angiography (MRA) continues to undergo exciting technological advances that are rapidly being translated into clinical practice. It also has evident advantages over other imaging modalities, including CT angiography and ultrasonography. With the aid of numerous high-quality illustrations, this book reviews the current role of MRA of the body. It is divided into three sections. The first section is devoted to issues relating to image acquisition technique and sequences, which are explored in depth. The second and principal section addresses the clinical applications of MRA in various parts of the body, including the neck vessels, the spine, the thoracic aorta and pulmonary vessels, the heart and coronary arteries, the abdominal aorta and renal arteries, and peripheral...
	Coronary CT Angiography by Marc Dewey (Author) Coronary CT angiography has attained increasing scientific attention at academic institutions and has become a highly accurate diagnostic modality. Extending this knowledge into a practice setting is the purpose of "Coronary CT Angiography". This book will assist you in integrating cardiac CT into your daily practice, while also giving an overview of the current technical status and applications. The specific features of scanners from all four main vendors are also presented providing an objective overview of noninvasive coronary angiography using CT.
	Retinal Angiography and Optical Coherence Tomography by J. Fernando Arévalo (Editor) OCT is a relatively new imaging technique that is becoming increasingly popular among ophthalmologists in both private and academic settings. Imaging has been a slow moving area in ophthalmology for some time, but now OCT is providing another, more detailed source of demonstrable change in the eye, in diagnostic, therapeutic or post-surgical setting. OCT and ultrasound both measure advancing disease states and post surgical healing. The difference is that OCT shows more subtle changes, particularly post-surgically.
	Cerebral Angiography: Normal Anatomy and Vascular Pathology by Gianni Boris Bradac (Author) Cerebral Angiography is a comprehensive and well-illustrated guide to the diagnostic use of cerebral angiography. The first part of the book depicts in detail the normal appearance of the cerebral vessels on angiographic studies. Sound knowledge of this normal vascular anatomy and clinical function is vital for correct interpretation of the clinical significance of the pathological processes addressed in the second part of the book. The latter include vascular abnormalities, including angiomas, fistulas, and aneurysms; atherosclerotic and non-atherosclerotic stenosis and occlusion of the cerebral vessels; and venous thrombosis. In each case, both typical and atypical appearances are presented. While the emphasis throughout is on the diagnostic value of cerebral angiography, a number of...
	Vascular CT Angiography Manual by Robert Pelberg (Author), Wojciech Mazur (Author) Despite the exponential growth in the use of peripheral CTA in the diagnosis and follow-up of vascular disease patients, practical sources from which to gain valuable expertise in this field remain scarce. There is becoming a great need for experts in the field of peripheral CTA, yet learning this imaging modality may be intimidating and time consuming. Very few if any, small, concise and portable books exist to ease training in this field and current books in this field are overwhelming, difficult to manage, text books that often combine CTA and MRI. A so called " how to manual" and reference guide to explain this technique from beginning to end, which compiles valuable, and difficult to obtain clinical pearls and descriptions of disease processes will be of tremendous value. The...
	Applied Angiography for Radiographers, 1e by Paul Laudicina MA RT(R) (Author), Douglas Wean AAS RT(R) (Author) This text chronologically presents the primary theories and applications of special radiologic procedures in a consistent organized manner. Topics include equipment, pharmacology, technique, positioning, anatomy and pathology, angiographic imaging and more. Included in the text are many high quality illustrations and radiographs which compare normal and abnormal studies. Multiple choice study questions are included at the end of each chapter making the text an ideal aid when preparing for certification examinations.
	Should all patients with cardiomyopathy have coronary angiography?(Pro & Con): An article from: Family Practice News by Stephen J. Green (Author), Avijit Lahiri (Author) This digital document is an article from Family Practice News, published by International Medical News Group on April 15, 2005. The length of the article is 825 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser. Citation Details Title: Should all patients with cardiomyopathy have coronary angiography?(Pro & Con) Author: Stephen J. Green Publication: Family Practice News (Magazine/Journal) Date: April 15, 2005 Publisher: International Medical News Group Volume: 35 Issue: 8 Page: 10(1) Distributed by Thomson...