Performance of Coronary CT Angiography to Rule Out Coronary Artery Disease After Out-of-hospital Cardiac Arrest (PERFECCT)

CHU de Reims

Status

Enrolling

Conditions

Out of Hospital Cardiac Arrest Without ST-segment Elevation

Treatments

Other: Coronary Calcium Score and Coronary CT angiogram

Study type

Interventional

Funder types

Other

Identifiers

NCT05961488

PA23075

Details and patient eligibility

About

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.

Full 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.

Enrollment

200 estimated patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

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