Literature DB >> 25943555

Editor's Choice-Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?

Idrees Salam1, Christian Hassager1, Jakob Hartvig Thomsen2, Sandra Langkjær1, Helle Søholm1, John Bro-Jeppesen1, Lia Bang1, Lene Holmvang1, David Erlinge3, Michael Wanscher4, Freddy K Lippert5, Lars Køber1, Jesper Kjaergaard1.   

Abstract

BACKGROUND: Current guidelines recommend that comatose out-of-hospital cardiac arrest patients with ST-segment elevations (STEs) following return of spontaneous circulation (ROSC) should be referred for an acute coronary angiography. We sought to investigate the diagnostic value of the pre-hospital ROSC-ECG in predicting ST-elevation myocardial infarction (STEMI).
METHOD: ROSC-ECGs of 145 comatose survivors of out-of-hospital cardiac arrest, randomly assigned in the Target Temperature Management trial, were classified according to the current STEMI ECG criteria (third universal definition of myocardial infarction).
RESULTS: STEs were present in the pre-hospital ROSC-ECG of 78 (54%) patients. A final diagnosis revealed that 69 (48%) patients had STEMI, 31 (21%) patients had non-STEMI and 45 (31%) patients had no myocardial infarction. STE in ROSC-ECGs had a sensitivity of 74% (95% confidence interval (CI) 62-84), specificity of 65% (95% CI 53-75) and a positive and negative predictive value of 65% (95% CI 54-76) and 73% (95% CI 61-83) in predicting STEMI. Time to ROSC was significantly longer (24 minutes vs. 19 minutes, P=0.02) in STE compared with no STE patients. Percutaneous coronary intervention was successful in 68% versus 36% (P<0.001) of STE compared to no STE patients. No significant difference was found in 180-day mortality rates between STE and no STE patients (36% vs. 30%, Plogrank=0.37).
CONCLUSION: The pre-hospital ROSC-ECG is a suboptimal diagnostic tool to predict STEMI and therefore not a sensitive tool for triage to cardiac centres. This supports the incentive of referring all comatose survivors of out-of-hospital cardiac arrest of suspected cardiac origin to a tertiary heart centre with the availability of acute coronary angiography, even in the absence of STEs. © The European Society of Cardiology 2015.

Entities:  

Keywords:  ECG; Out-of-hospital cardiac arrest (OHCA); ST-segment elevation; STEMI; acute coronary angiography; triage

Mesh：

Year:  2015        PMID： 25943555     DOI： 10.1177/2048872615585519

Source DB:  PubMed          Journal:  Eur Heart J Acute Cardiovasc Care        ISSN： 2048-8726


  4 in total

1.  [Are emergency physicians influenced by nonmedical aspects in their choice of the hospital : Observations in 280 victims of out-of-hospital cardiac arrest in times of hospital alliances].

Authors:  M Christ; K I von Auenmüller; S Amirie; B M Sasko; M Brand; H-J Trappe
Journal:  Med Klin Intensivmed Notfmed       Date:  2016-07-19       Impact factor: 0.840

2.  Cardiologists appropriately exclude resuscitated out-of-hospital cardiac arrests from emergency coronary angiography.

Authors:  Melanie R Wittwer; Chris Zeitz; Sunny Wu; Kumaril Mishra; Sharmalar Rajendran; John F Beltrame; Margaret A Arstall
Journal:  J Am Coll Emerg Physicians Open       Date:  2020-10-20

Review 3.  [Cardiac arrest under special circumstances].

Authors:  Carsten Lott; Anatolij Truhlář; Anette Alfonzo; Alessandro Barelli; Violeta González-Salvado; Jochen Hinkelbein; Jerry P Nolan; Peter Paal; Gavin D Perkins; Karl-Christian Thies; Joyce Yeung; David A Zideman; Jasmeet Soar
Journal:  Notf Rett Med       Date:  2021-06-10       Impact factor: 0.826

4.  Do not disregard the initial 12 lead ECG after out-of-hospital cardiac arrest: It predicts angiographic culprit despite metabolic abnormalities.

Authors:  Amit Sharma; David F Miranda; Holly Rodin; Bradley A Bart; Stephen W Smith; Gautam R Shroff
Journal:  Resusc Plus       Date:  2020-10-01
  4 in total

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