{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T04:03:14Z","timestamp":1777089794226,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100002076","name":"Emergency Medicine Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002076","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007619","name":"Society for Academic Emergency Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R21NS109763"],"award-info":[{"award-number":["1R21NS109763"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Out\u2010of\u2010hospital cardiac arrest (OHCA) afflicts &gt;350,000 people annually in the United States. While postarrest coronary angiography (CAG) with percutaneous coronary intervention (PCI) has been associated with improved survival in observational cohorts, substantial uncertainty exists regarding patient selection for postarrest CAG. We tested the hypothesis that symptoms consistent with acute coronary syndrome (ACS), including chest discomfort, prior to OHCAs are associated with significant coronary lesions identified on postarrest CAG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a multicenter retrospective cohort study among eight regional hospitals. Adult patients who experienced atraumatic OHCA with successful initial resuscitation and subsequent CAG between January 2015 and December 2019 were included. We collected data on prehospital documentation of potential ACS symptoms prior to OHCA as well as clinical factors readily available during postarrest care. The primary outcome in multivariable regression modeling was the presence of significant coronary lesions (defined as &gt;50% stenosis of left main or &gt;75% stenosis of other coronary arteries).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four\u2010hundred patients were included. Median (interquartile range) age was 59 (51\u201369)\u00a0years; 31% were female. At least one significant stenosis was found in 62%, of whom 71% received PCI. Clinical factors independently associated with a significant lesion included a history of myocardial infarction (adjusted odds ratio [aOR]\u00a0= 6.5, [95% confidence interval {CI}\u00a0=\u00a01.3 to 32.4], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.02), prearrest chest discomfort (aOR\u00a0= 4.8 [95% CI\u00a0=\u00a02.1 to 11.8], <jats:italic>p<\/jats:italic>\u00a0\u2264\u00a00.001), ST\u2010segment elevations (aOR\u00a0= 3.2 [95% CI\u00a0=\u00a01.7 to 6.3], <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), and an initial shockable rhythm (aOR\u00a0=\u00a01.9 [95% CI\u00a0=\u00a01.0 to 3.4], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among survivors of OHCA receiving CAG, history of prearrest chest discomfort was significantly and independently associated with significant coronary artery lesions on postarrest CAG. This suggests that we may be able to use prearrest symptoms to better risk stratify patients following OHCA to decide who will benefit from invasive angiography.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14416","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T17:16:27Z","timestamp":1636737387000},"page":"456-464","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Clinical factors associated with significant coronary lesions following out\u2010of\u2010hospital cardiac arrest"],"prefix":"10.1111","volume":"29","author":[{"given":"David R.","family":"Helfer","sequence":"first","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew R.","family":"Helber","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aarika R.","family":"Ferko","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Reading Hospital  Reading Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel D.","family":"Klein","sequence":"additional","affiliation":[{"name":"Lewis Katz School of Medicine Temple University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel\u00a0S.","family":"Elchediak","sequence":"additional","affiliation":[{"name":"Lewis Katz School of Medicine Temple University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Traci S.","family":"Deaner","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Reading Hospital  Reading Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dustin","family":"Slagle","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine ChristianaCare  Newark Delaware USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William B.","family":"White","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine ChristianaCare  Newark Delaware USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6018-8282","authenticated-orcid":false,"given":"David G.","family":"Buckler","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  Mount Sinai New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar J. L.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Division of Pulmonary, Allergy and Critical Care Medicine Department of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul N.","family":"Fiorilli","sequence":"additional","affiliation":[{"name":"Cardiovascular Division Department of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4452-5939","authenticated-orcid":false,"given":"Derek","family":"Isenberg","sequence":"additional","affiliation":[{"name":"Lewis Katz School of Medicine Temple University  Philadelphia Pennsylvania 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