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

Salam, Idrees ; Hassager, Christian ; Thomsen, Jakob Hartvig ; Langkjær, Sandra ; Søholm, Helle ; Bro-Jeppesen, John ; Bang, Lia ; Holmvang, Lene ; Erlinge, David LU and Wanscher, Michael , et al. (2016) In European heart journal. Acute cardiovascular care 5(4). p.317-326
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... (More)

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.

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publishing date
type
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publication status
published
subject
keywords
acute coronary angiography, ECG, Out-of-hospital cardiac arrest (OHCA), ST-segment elevation, STEMI, triage
in
European heart journal. Acute cardiovascular care
volume
5
issue
4
pages
10 pages
publisher
SAGE Publications
external identifiers
  • scopus:85050578702
  • pmid:25943555
ISSN
2048-8734
DOI
10.1177/2048872615585519
language
English
LU publication?
no
id
e11650bc-496b-4914-8a4b-7b0477e9b9e2
date added to LUP
2019-05-23 10:31:38
date last changed
2020-01-30 03:45:11
@article{e11650bc-496b-4914-8a4b-7b0477e9b9e2,
  abstract     = {<p>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).</p><p>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).</p><p>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&lt;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).</p><p>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.</p>},
  author       = {Salam, Idrees and Hassager, Christian and Thomsen, Jakob Hartvig and Langkjær, Sandra and Søholm, Helle and Bro-Jeppesen, John and Bang, Lia and Holmvang, Lene and Erlinge, David and Wanscher, Michael and Lippert, Freddy K. and Køber, Lars and Kjaergaard, Jesper},
  issn         = {2048-8734},
  language     = {eng},
  month        = {08},
  number       = {4},
  pages        = {317--326},
  publisher    = {SAGE Publications},
  series       = {European heart journal. Acute cardiovascular care},
  title        = {Editor's Choice-Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?},
  url          = {http://dx.doi.org/10.1177/2048872615585519},
  doi          = {10.1177/2048872615585519},
  volume       = {5},
  year         = {2016},
}