{
  "abstract": "Background Emergency coronary angiography is recommended for out-of-hospital cardiac arrest (OHCA) patients with ST-segment elevation (STE); however, cath-lab triage remains challenging in patients with an initial shockable rhythm without STE. The British Cardiovascular Interventional Society (BCIS) conveyance algorithm expedites transfer of OHCA patients with STE or shockable rhythms to cardiac arrest centres (CAC), aiming to enrich for a coronary aetiology. Real-world data evaluating angiographic findings within this pathway are limited.Aim To evaluate angiographic yield, coronary phenotypes, and revascularisation strategies in OHCA patients meeting BCIS conveyance criteria who underwent emergency coronary angiography.Methods We analysed consecutive OHCA patients admitted to a tertiary CAC serving a population of 2.2 million between October 2020 and November 2020. Patients meeting BCIS conveyance criteria (shockable initial rhythm and/or STEMI) who underwent emergency coronary angiography within 2 hours of arrival were included. Angiographic findings were categorised into four predefined phenotypes:acute thrombotic culprit lesion;acute non-occlusive coronary pathology;severe chronic obstructive coronary artery disease without a clear acute lesion;no obstructive coronary artery disease.Results Of 621 OHCA patients meeting BCIS conveyance criteria, 550 (88.5%) underwent emergency coronary angiography. Of these, 236 (43%) had STEMI with a shockable rhythm, 285 (52%) had a shockable rhythm without STEMI, and 27 (5%) had STEMI with an initial non- shockable rhythm.Abnormal coronary angiography was observed in 441 patients (80%). Acute thrombotic culprit lesions (phenotype A) were identified in 208 patients (47%), acute non-occlusive coronary pathology (phenotype B) in 65 (12%), severe chronic obstructive coronary disease without a clear acute lesion (phenotype C) in 118 (22%), and no obstructive coronary disease (phenotype D) in 107 (20%).Among patients with acute thrombotic lesions (phenotype A), 183 (71%) had STE on the admission ECG, while 75 (29%) did not. Overall, 75/285 (26%) of shockable non-STE patients had an acute thrombotic lesion, and 38/285 (13%) had acute non-occlusive coronary pathology. Among non-STE patients with acute coronary pathology (phenotypes A–B), 68 (60%) had evidence of cardiogenic shock (SCAI B–E) on arrival.Conclusion Emergency coronary angiography in OHCA patients referred under the BCIS conveyance algorithm demonstrates high diagnostic yield with substantial heterogeneity in coronary phenotypes. A significant proportion of shockable OHCA patients without STE had acute angiographic coronary pathology, supporting the algorithm’s ability to identify patients with occult coronary aetiology. Further work is required to refine clinical and electrocardiographic risk stratification to optimise cath-lab triage after OHCA.Abstract 465 Figure 1Abstract 465 Figure 2Flow diagram of OHCA patients referred under BCIS conveyance algorithm, stratified by STE and coronary angiogram findings",
  "authors": [
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, United Kingdom",
        "MTRC, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom"
      ],
      "name": "Uzma Sajjad"
    },
    {
      "affiliations": [
        "MTRC, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom"
      ],
      "name": "Miss Soyun Choi"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, United Kingdom",
        "MTRC, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom"
      ],
      "name": "Guilherme Movio"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, United Kingdom",
        "MTRC, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom"
      ],
      "name": "Rupert Simpson"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, United Kingdom",
        "MTRC, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom"
      ],
      "name": "Chloe Knight"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, United Kingdom"
      ],
      "name": "Vishnuga Uthayamohan"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, United Kingdom"
      ],
      "name": "Emteaz Hassan"
    },
    {
      "affiliations": [
        "MTRC, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom"
      ],
      "name": "Amna Illahi"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, United Kingdom"
      ],
      "name": "Keval Patel"
    },
    {
      "affiliations": [
        "Princess Alexandra Hospital, Harlow, United Kingdom"
      ],
      "name": "Tariq Salarbux"
    },
    {
      "affiliations": [
        "Southend University Hospital, Mid and South Essex NHS Trust, Southend, United Kingdom"
      ],
      "name": "Kamran Dawood"
    },
    {
      "affiliations": [
        "Princess Alexandra Hospital, Harlow, United Kingdom"
      ],
      "name": "Tudor Sandutu"
    },
    {
      "affiliations": [
        "Colchester Hospital, East Suffolk and North Essex NHS Trust, Colchester, United Kingdom"
      ],
      "name": "Mohammad Khan Tharin"
    },
    {
      "affiliations": [
        "King’s College Hospital, London, United Kingdom",
        "chool of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Excellence, King’s College, London, United Kingdom"
      ],
      "name": "Nilesh Pareek"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, United Kingdom",
        "MTRC, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom"
      ],
      "name": "John Davies"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, United Kingdom",
        "MTRC, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom"
      ],
      "name": "Thomas Keeble"
    }
  ],
  "title": "465 Angiographic findings in shockable out-of-hospital cardiac arrest referred under the BCIS conveyance algorithm",
  "uid": "ffbc53e1-42c5-5001-b88a-ca8f2597d91d"
}