Risk Assessment in Immediate Versus Delayed Angiography after Out-of-Hospital Cardiac Arrest Without ST Segment Elevation Decisions

We appreciate the interest Dorian and Dorian have shown in the Canadian Cardiovascular Society's (CCS) Clinical Practice Update (CPU). 1 van Diepen S. Le May M.R. Alfaro P. Goldfarb M.J. Luk A. Mathew R. et al. Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care. Can J Cardiol. 2024; 40: 524-539 Google Scholar In the text of the timing of angiography subsection, we highlighted the results of 6 multi-centre randomized controlled trials and a meta-analysis of randomized controlled trials and state that routine early coronary angiography is "not beneficial in comatose survivors" of out-of-hospital cardiac arrest (OHCA) without ST-elevation myocardial infarction (STEMI), but also convey that there is some heterogeneity in this patient population and some common high-risk subgroups were excluded from the aforementioned RCTS and may warrant consideration for immediate angiography. 1 van Diepen S. Le May M.R. Alfaro P. Goldfarb M.J. Luk A. Mathew R. et al. Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care. Can J Cardiol. 2024; 40: 524-539 Google Scholar Contemporary Risk Assessment of Aortic Root Injury for New-Generation Balloon-Expandable Transcatheter Heart ValvesCanadian Journal of CardiologyPreviewOne of the most devastating complications of transcatheter aortic valve replacement (TAVR) is aortic root injury (ARI). However, existing risk analyses are based on early TAVR practice with first-generation devices and different sizing approaches. Here, we introduce a revised approach for a more contemporary assessment of the risk of ARI. This includes the adjustment of sizing thresholds, a careful consideration of the entire aortic root anatomy to rule out an incongruently small sinotubular junction (STJ), and customized positioning recommendations according to the underlying risk factors. Full-Text PDF Immediate Versus Delayed Angiography after Out-of-Hospital Cardiac Arrest Without ST Segment ElevationCanadian Journal of CardiologyPreviewIn the detailed and comprehensive Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care,1 in the subsection titled "Coronary angiography in patients with OHCA without a STEMI", the authors state "In patients who are comatose after a resuscitated OHCA without ST-segment elevation on the initial ECG, delaying coronary angiography may be considered (our emphasis) unless high-risk cardiovascular features are present such as hemodynamic instability, high-risk ischemic ECG changes, or recurrent, or unstable ventricular arrhythmias believed to be related to ongoing ischemia." Full-Text PDF