Diagnostic tools to improve clinical outcome in acute cardiac disease: From out-of-hospital cardiac arrest to acute coronary syndrome

In this thesis, several invasive methods are described, as the main coronary angiography, to evaluate epicardial and microvascular coronary artery disease and improve the clinical prognosis in patients with acute and chronic cardiac diseases. Many cardiac catheterizations are performed daily, whether or not followed by angioplasty to reopen a coronary artery. However, in several acute cardiac patients, such as with out-of-hospital cardiac arrest without ST-elevation and with so-called “transient STEMI”, it is unclear what the optimal time is for a diagnostic coronary angiography and revascularization for the best clinical outcomes. The thesis consists of three parts and focuses on strategies to optimize clinical outcomes: (i) the optimal timing of cardiac catheterization in patients with out-of-hospital cardiac arrest without ST-elevation, (ii) the optimal timing of coronary angiography and revascularization in transient STEMI patients and (iii) improvement of microvascular function through side effects of anticoagulant therapy in STEMI patients. The first part of a multicenter randomized trial describes that immediate or delayed cardiac catheterization and revascularization provide equally good outcomes for survival up to 90 days and 1 year in patients with out-of-hospital cardiac arrest without ST-elevation. In part two, transient STEMI showed a favorable outcome for infarct size of both randomized intervention moments, so the treatment strategy can be based on logistical or cost-effective considerations. Furthermore, the thesis describes an international multicenter randomized trial showing that the anticoagulant drugs ticagrelor and prasugrel make no difference for microvascular injury and infarct size in patients with acute myocardial infarction.