NEW YORK (AP) — The city medical examiner ruled Friday that a police officer's chokehold caused the death of a man whose videotaped arrest and final pleas of "I can't breathe!" sparked outrage and led to the announcement of an overhaul of use-of-force training for the nation's largest police department.

Eric Garner, a black man whose confrontation with a white police officer has prompted calls by the Rev. Al Sharpton for federal prosecution, was killed by neck compressions from the chokehold and "the compression of his chest and prone positioning during physical restraint by police," medical examiner's spokeswoman Julie Bolcer said.

Asthma, heart disease and obesity were contributing factors in the death of the 43-year-old Garner, a 6-foot-3, 350-pound father of six, she said.

The finding increases the likelihood that the case will be presented to a grand jury to determine whether Officer Daniel Pantaleo, who placed Garner in the chokehold, or any other officers involved in the confrontation will face criminal charges. Pantaleo's attorney, Stuart London, declined to comment.

Garner's wife, Esaw Garner, told the Daily News, "Thank God the truth is finally out."

Mayor Bill de Blasio extended his sympathies to Garner's family in a statement and pledged to continue repairing the relationship between minority communities and the New York Police Department.

"I've said that we would make change, and we will," he said.

Partial video of the July 17 confrontation shows an officer placing a chokehold on Garner, who was being arrested on suspicion of selling untaxed, loose cigarettes. Garner then apparently loses consciousness.

Chokeholds are prohibited by the NYPD.

Prosecutors on Staten Island, where the confrontation occurred, are investigating. A spokesman for District Attorney Daniel Donovan said prosecutors were still investigating the death and awaited a full autopsy report and death certificate from the medical examiner. Donovan will have to determine whether to empanel a grand jury and charge officers in Garner's death.

Federal officials are monitoring the investigation, a Department of Justice spokeswoman said, adding that the department has not begun its own inquiry.

Police Commissioner Bill Bratton said officials were aware of the medical examiner's findings and the department is cooperating with prosecutors. He has said the NYPD's use-of-force training is lacking and has pledged to retrain all 35,000 officers.

Pantaleo was stripped of his gun and badge pending the investigation, and another officer was placed on desk duty. Two paramedics and two emergency medical technicians were suspended without pay.

The president of the powerful Patrolmen's Benevolent Association, Patrick Lynch, expressed his sympathies to Garner's family but noted Garner "was a man with serious health problems."

"We believe, however, that if he had not resisted the lawful order of the police officers placing him under arrest, this tragedy would not have occurred," he said.

Garner's family will join Sharpton on Saturday to address the medical examiner's ruling, a spokeswoman said.

Ramsey Orta, a friend of Garner's who videotaped his struggle with police, said the medical examiner's ruling wasn't surprising.

"I knew that was the cause because I saw it," he said. "Now somebody should get charged."

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Associated Press writers Eric Tucker in Washington and Jonathan Lemire contributed.