Clinical Implication of Coronary Artery Calcium Score in Survivors of Out-of-Hospital Cardiac Arrest

Background: The aim of this study was to evaluate the clinical ability of coronary artery calcium (CAC) score to identify acute myocardial infarction (AMI) in survivors of out-of-hospital cardiac arrest (OHCA). Methods and Results: We studied 180 consecutive survivors of OHCA who underwent immediate non-contrast computed tomography (CT) and coronary angiography. Seventy-one patients had ST elevation or left bundle branch block (LBBB; group 1) and 109 patients did not have ST elevation or LBBB (group 2) on post-resuscitation electrocardiogram (ECG). CAC score was significantly higher in AMI compared with non-AMI in groups 1 and 2. The optimal cut-off of CAC score to identify AMI was 11.5 (sensitivity, 80%; specificity, 71%) in group 1, and 27.4 (sensitivity, 80%; specificity, 76%) in group 2. On multivariate analysis, CAC score was the strongest predictive marker of AMI (OR, 10.91; 95% CI: 6.00–25.97). In addition, CAC score was an independent predictor of 30-day survival (OR, 0.38; 95% CI: 0.15–0.95). Conclusions: Evaluation of CAC is a useful method to identify AMI in survivors of OHCA, regardless of ST changes on post-resuscitation ECG.