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

Zanuttini, Davide; Armellini, Ilaria; Nucifora, Gaetano; Grillo, Maria Teresa; Morocutti, Giorgio; Carchietti, Elio; Trillò, Giulio; Spedicato, Leonardo; Bernardi, Guglielmo; Proclemer, Alessandro

doi:10.1016/j.resuscitation.2013.04.023

Cited by 91 publications

(64 citation statements)

References 21 publications

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“…We did not include the ECG pattern (absence or presence of ST-segment-elevation) in our analysis because it was never used in our algorithm decision to perform or not an immediate coronary angiogram. We and others 1,5,[24][25][26] have demonstrated that clinical data, ECG, and biomarkers lack specificity and sensitivity to predict an acute coronary occlusion as the cause of OHCA. We therefore favor performing an immediate coronary angiogram at admission in all survivors of OHCA without an obvious noncardiac cause of arrest, regardless of the ECG aspect.…”

Section: Coro W/ Pcimentioning

confidence: 96%

Immediate Percutaneous Coronary Intervention Is Associated With Improved Short- and Long-Term Survival After Out-of-Hospital Cardiac Arrest

Géri

Dumas

Bougouin

et al. 2015

Circ: Cardiovascular Interventions

116

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Background-Whether to perform or not an immediate percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest is still debated. We aimed to evaluate the impact of PCI on short-and long-term survival in out-of-hospital cardiac arrest patients admitted after successful resuscitation. Methods and Results-Between 2000 and 2013, all nontrauma out-of-hospital cardiac arrest patients admitted in a Parisian cardiac arrest center after return of spontaneous circulation were prospectively included. The association between immediate PCI and short-and long-term mortality was analyzed using logistic regression and Cox multivariate analysis, respectively. Propensity score-matching method was used to assess the influence of PCI on short-and long-term survival.

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Section: Coro W/ Pcimentioning

confidence: 96%

Immediate Percutaneous Coronary Intervention Is Associated With Improved Short- and Long-Term Survival After Out-of-Hospital Cardiac Arrest

Géri

Dumas

Bougouin

et al. 2015

Circ: Cardiovascular Interventions

116

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“…Clinical data have been conflicting and consist mainly of retrospective studies, registry data, and observational studies on patients already selected for coronary angiography based Post-Resuscitation ECG and ICA Findings on ECG findings. [9][10][11] The net benefit of referring all OHCA patients to ICA is therefore uncertain and under debate. 12 Important aspects are delays in optimal bundle care treatment, logistic challenges during inter-and intrahospital referral to institutions with 24/7 coronary angiography service, total outcome benefit, finances, and resources.…”

Section: See Editorial By Lotun and Kernmentioning

confidence: 99%

Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest

Stær-Jensen

Nakstad

Fossum

et al. 2015

Circ: Cardiovascular Interventions

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Background-We aimed to investigate coronary angiographic findings in unselected out-of-hospital cardiac arrest patients referred to immediate coronary angiography (ICA) irrespective of their first postresuscitation ECG and to determine whether this ECG is useful to select patients with no need of ICA. Methods and Results-All resuscitated patients admitted after out-of-hospital cardiac arrest without a clear noncardiac cause underwent ICA. Patients were retrospectively grouped according to the postresuscitation ECG blinded for ICA results: (1) ST elevation or presumably new left bundle branch block, (2) other ECG signs indicating myocardial ischemia, and (3) no ECG signs indicating myocardial ischemia. All coronary angiograms were reevaluated blinded for postresuscitation ECGs. Two hundred and ten patients were included with mean age 62±12 years. Six-months survival with good neurological outcome was 54%. Reduced Thrombolysis in Myocardial Infarction flow (0-2) was found in 55%, 34%, and 18% and a ≥90% coronary stenosis was present in 25%, 27%, and 19% of patients in group 1, 2, and 3, respectively. An acute coronary occlusion was found in 11% of patients in group 3. ST elevation/left bundle branch block identified patients with reduced Thrombolysis in Myocardial Infarction (0-2) flow with 70% sensitivity and 62% specificity. Among patients with initial nonshockable rhythms (24%), 32% had significantly reduced Thrombolysis in Myocardial Infarction flow. Conclusions-Initial ECG findings are not reliable in detecting patients with an indication for ICA after experiencing a cardiac arrest. Even in the absence of ECG changes indicating myocardial ischemia, an acute culprit lesion may be present and patients may benefit from emergent revascularization. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01239420.(Circ Cardiovasc Interv. 2015;8:e002784.

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“…Bulut et al [13] found no mortality benefit of performing PCI at all. Study done by Zanuttini et al [14] and Spaulding et al [15] suggested that electrocardiogram should not be a criterion to perform coronary angiography (CA)/PCI in cardiac arrest patients. There is very sparse real time national data on outcomes of cardiac arrest post PCI.…”

Section: Introductionmentioning

confidence: 99%

Impact of Percutaneous Coronary Intervention on in Hospital Mortality in Cardiac Arrest – A National Perspective

Tripathi¹,

Arora²,

Panaich³

et al. 2016

Angiol

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

Cited by 91 publications

References 21 publications

Immediate Percutaneous Coronary Intervention Is Associated With Improved Short- and Long-Term Survival After Out-of-Hospital Cardiac Arrest

Immediate Percutaneous Coronary Intervention Is Associated With Improved Short- and Long-Term Survival After Out-of-Hospital Cardiac Arrest

Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest

Impact of Percutaneous Coronary Intervention on in Hospital Mortality in Cardiac Arrest – A National Perspective

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