Editor's Choice-Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?. Issue 4 (1st August 2016)

• Record Type: Journal Article
• Authors: Salam, Idrees; Hassager, Christian; Thomsen, Jakob Hartvig; Langkjær, Sandra; Søholm, Helle; Bro-Jeppesen, John; Bang, Lia; Holmvang, Lene; Erlinge, David; Wanscher, Michael; Lippert, Freddy K; Køber, Lars; Kjaergaard, Jesper
• Is Part Of: European heart journal. Volume 5:Issue 4(2016)
• Page Start: 317
• Page End: 326
• Publication Date: 2016-08-01
• Subjects: Out-of-hospital cardiac arrest (OHCA) -- ECG -- ST-segment elevation -- STEMI -- acute coronary angiography -- triage; 616.1205
• DOI: 10.1177/2048872615585519
• Languages: English
• ISSNs: 2048-8726

Abstract

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%, P logrank =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.