Ischaemic electrocardiogram patterns and its association with survival in out-of-hospital cardiac arrest patients without ST-segment elevation myocardial infarction: a COACT trials' post-hoc subgroup analysis
Spoormans, Eva M; Lemkes, Jorrit S; Janssens, Gladys N; Soultana, Ouissal; van der Hoeven, Nina W; Jewbali, Lucia S D; Dubois, Eric A; Meuwissen, Martijn; Rijpstra, Tom A; Bosker, Hans A; Blans, Michiel J; Bleeker, Gabe B; Baak, Remon; Vlachojannis, Georgios J; Eikemans, Bob J W; van der Harst, Pim; van der Horst, Iwan C C; Voskuil, Michiel; van der Heijden, Joris J; Beishuizen, Albertus; Stoel, Martin; Camaro, Cyril; van der Hoeven, Hans; Henriques, José P; Vlaar, Alexander P J; Vink, Maarten A; van den Bogaard, Bas; Heestermans, Ton A C M; de Ruijter, Wouter; Delnoij, Thijs S R; Crijns, Harry J G M; Oemrawsingh, Pranobe V; Gosselink, Marcel T M; Plomp, Koos; Magro, Michael; Elbers, Paul W G; van de Ven, Peter M; van Royen, Niels
(2022) European heart journal. Acute cardiovascular care, volume 11, issue 7, pp. 535 - 543
(Article)
Abstract
AIMS: ST-depression and T-wave inversion are frequently present on the post-resuscitation electrocardiogram (ECG). However, the prognostic value of ischaemic ECG patterns is unknown. METHODS AND RESULTS: In this post-hoc subgroup analysis of the Coronary Angiography after Cardiac arrest (COACT) trial, the first in-hospital post-resuscitation ECG in out-of-hospital cardiac arrest patients
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with a shockable rhythm was analysed for ischaemic ECG patterns. Ischaemia was defined as ST-depression of ≥0.1 mV, T-wave inversion in ≥2 contiguous leads, or both. The primary endpoint was 90-day survival. Secondary endpoints were rate of acute unstable lesions, levels of serum troponin-T, and left ventricular function. Of the 510 out-of-hospital cardiac arrest patients, 340 (66.7%) patients had ischaemic ECG patterns. Patients with ischaemic ECG patterns had a worse 90-day survival compared with those without [hazard ratio 1.51; 95% confidence interval (CI) 1.08-2.12; P = 0.02]. A higher sum of ST-depression was associated with lower survival (log-rank = 0.01). The rate of acute unstable lesions (14.5 vs. 15.8%; odds ratio 0.90; 95% CI 0.51-1.59) did not differ between the groups. In patients with ischaemic ECG patterns, maximum levels of serum troponin-T (μg/L) were higher [0.595 (interquartile range 0.243-1.430) vs. 0.359 (0.159-0.845); ratio of geometric means 1.58; 1.13-2.20] and left ventricular function (%) was worse (44.7 ± 12.5 vs. 49.9 ± 13.3; mean difference -5.13; 95% CI -8.84 to -1.42). Adjusted for age and time to return of spontaneous circulation, ischaemic ECG patterns were no longer associated with survival. CONCLUSION: Post-arrest ischaemic ECG patterns were associated with worse 90-day survival. A higher sum of ST-depression was associated with lower survival. Adjusted for age and time to return of spontaneous circulation, ischaemic ECG patterns were no longer associated with survival.
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Keywords: Cardiac arrest, Coronary Angiography/methods, ECG, Electrocardiography/methods, Humans, Ischaemia, Left ventricular function, Out-of-Hospital Cardiac Arrest/therapy, ST Elevation Myocardial Infarction, Shockable rhythm, Troponin T, Journal Article, Clinical Trial
ISSN: 2048-8726
Publisher: SAGE Publications Ltd
Note: Publisher Copyright: © 2022 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
(Peer reviewed)