Coronary angiography findings in patients with refractory out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: prediction of lesion culprit of acute myocardial infarction

Background: In patients with refractory Out-of-hospital Cardiac Arrest (r-OHCA) treated with Extracorporeal Cardiopulmonary Resuscitation (ECPR), the optimal timing and indications for Coronary Angiography remain uncertain. This study aimed to identify clinical variables at admission that are associated with the presence of an acute myocardial infarction as cause of refractory cardiac arrest. Methods: In this retrospective study we analyzed the association between characteristics at hospital admission and the presence of a culprit lesion of acute myocardial infarction in a population of r-OHCA patients treated with ECPR. Results: A total of 129 patients were included. At a multivariable logistic regression analysis male sex (OR = 4.02, 95 %CI 1.14-15.08), age (OR = 1.08, 95 %CI = 1.03-1.13) and chest pain before cardiac arrest (OR = 5.58, 95 %CI = 1.95-15.93) were independent predictor of the presence of a culprit lesion, while a history of heart failure (OR = 0.02, 95 %CI = 0.00-0.16) and obesity (OR = 0.32, 95 %CI 0.10-1.01) were associated with a lower likelihood. The model achieved an area under the curve (AUC) of 0.87, indicating strong discriminative power. Conclusion: These findings suggest that clinical characteristics available at admission can help predict the presence of an infarct-related culprit lesion in patients with r-OHCA, thereby refining the decision-making process for emergent CAG. Incorporating these predictors into clinical practice may reduce unnecessary procedures and guide alternative diagnostic approaches. The Institutional Ethics Committee (Local Ethical Committee "Lombardia 3") approved the study (ID: 5721_12.03.2025).