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.
(Less)
- author
- 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. (More)
- Salam, Idrees
; Hassager, Christian
; Thomsen, Jakob Hartvig
; Langkjær, Sandra
; Søholm, Helle
; Bro-Jeppesen, John
; Bang, Lia
; Holmvang, Lene
; Erlinge, David
LU
; Wanscher, Michael
; Lippert, Freddy K.
; Køber, Lars
and Kjaergaard, Jesper
(Less)
- publishing date
- 2016-08-01
- type
- Contribution to journal
- 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
- Oxford University Press
- 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
- 2024-05-28 13:08:00
@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<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}},
keywords = {{acute coronary angiography; ECG; Out-of-hospital cardiac arrest (OHCA); ST-segment elevation; STEMI; triage}},
language = {{eng}},
month = {{08}},
number = {{4}},
pages = {{317--326}},
publisher = {{Oxford University Press}},
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}},
}