Elsevier

Resuscitation

Volume 84, Issue 9, September 2013, Pages 1250-1254
Resuscitation

Clinical paper
Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest

https://doi.org/10.1016/j.resuscitation.2013.04.023Get rights and content

Abstract

Aims

Acute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). Aim of the present study was to assess the predictive value of ST-segment changes in diagnosing the presence of acute coronary lesions among OHCA patients

Methods

Findings of coronary angiography (CA) performed in patients resuscitated from OCHA were retrospectively reviewed and related to ST-segment changes on post-ROSC electrocardiogram (ECG)

Results

Ninety-one patients underwent CA after OHCA; 44% of patients had ST-segment elevation and 56% of patients had other ECG patterns on post-ROSC ECG. Significant coronary artery disease (CAD) was found in 86% of patients; CAD was observed in 98% of patients with ST-segment elevation and in 77% of patients with other ECG patterns on post-ROSC ECG (p = 0.004). Acute or presumed recent coronary artery lesions were diagnosed in 56% of patients, respectively in 85% of patients with ST-segment elevation and in 33% of patients with other ECG patterns (p < 0.001). ST-segment analysis on post-ROSC ECG has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (85% and 67%, respectively)

Conclusions

Electrocardiographic findings after OHCA should not be considered as strict selection criteria for performing emergent CA in patients resuscitated from OHCA without obvious extra-cardiac cause; even in the absence of ST-segment elevation on post-ROSC ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest

Introduction

Out-of-Hospital Cardiac Arrest (OHCA) is still a leading cause of death worldwide. Acute myocardial ischemia is known to be the most common trigger of sudden cardiac arrest.1, 2, 3 Recent data suggest that early coronary angiography and percutaneous coronary intervention after OHCA may improve hospital survival of these patients.3, 4 Decision to perform emergent coronary angiography is classically taken on the basis of electrocardiographic (ECG) findings after recovery of spontaneous circulation (ROSC). According to current guidelines, the presence of ST-segment elevation or presumed new left bundle-branch block is considered an indication for emergent coronary angiography.5 Conversely, in patients without ST-segment elevation the usefulness of emergent coronary angiography is still controversial.3, 4, 6, 7, 8 Accordingly, aim of the present study was to assess the relation between post-ROSC ECG and the presence of acute or presumed recent coronary artery lesions as possible cause of OHCA.

Section snippets

Study population

Province of Udine has approximately 550,000 inhabitants, which is served by a comprehensive centrally co-ordinated ambulance system (118 Operative Station). OHCA patients in whom ROSC is achieved are referred to our Institution, which is a tertiary care referral center with intensive care unit, coronary care unit and coronary intervention facility available 24 h a day, 7 days a week.

A retrospective analysis of all patients admitted to the Catheterization Laboratory of our Institution undergoing

Results

During the study period, 126 patients who fulfilled the inclusion criteria were admitted to our Institution after resuscitation from OHCA; 35 patients did not undergo coronary angiography (Fig. 1). Ninety-one patients underwent coronary angiography and were included in the study. Eighty-five patients (93%) were comatose at the time of hospital admission.

Forty patients (44%) had ST-segment elevation on post ROSC ECG, whereas other ECG patterns were observed in the remaining 51 (56%) patients.

Discussion

The results of the present study can be summarized as follows: (1) coronary angiography demonstrates the presence of acute or presumed recent coronary artery lesions in a high proportion of OHCA survivors without ST-segment elevation on post-ROSC ECG; (2) analysis of ST-segment changes on post-ROSC ECG has a low sensitivity and negative predictive value for the identification of patients having acute or presumed recent coronary artery lesions.

Post-mortem studies documented a high prevalence of

Conclusions

The absence of ST segment elevation on post-ROSC ECG should not be considered as a criterion for not performing or delaying emergency coronary angiography in patients resuscitated from OHCA without obvious extra-cardiac cause, because acute culprit coronary lesions may be present and considered the trigger of cardiac arrest. However it is conceivable that some individual factors, such the presence of previous co-morbidities with short life expectancy and the absence of a realistic hope for

Conflict of interest statement

The authors have no conflict of interest to declare.

References (22)

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.04.023

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