Value of post-resuscitation electrocardiogram in the diagnosis of acute myocardial infarction in out-of-hospital cardiac arrest patients

Autor: Dragos Daniel Capan, Victor Stratiev, Mounir Aout, Nicolas Deye, Benoît Vivien, P. Brun, Sebastian Voicu, Bruno Mégarbane, Jean-Guillaume Dillinger, Georgios Sideris, Claire Broche, Frédéric J. Baud, Damien Logeart, Patrick Henry
Rok vydání: 2011
Předmět:
Male
Emergency Medical Services
medicine.medical_specialty
Resuscitation
medicine.medical_treatment
Myocardial Infarction
Emergency Nursing
Return of spontaneous circulation
Coronary Angiography
Risk Assessment
Sensitivity and Specificity
Statistics
Nonparametric
Cohort Studies
Electrocardiography
Internal medicine
Angioplasty
Intensive care
Humans
Medicine
cardiovascular diseases
Myocardial infarction
Angioplasty
Balloon
Coronary
Aged
Retrospective Studies
Chi-Square Distribution
medicine.diagnostic_test
business.industry
Left bundle branch block
Middle Aged
medicine.disease
Survival Analysis
Cardiopulmonary Resuscitation
Treatment Outcome
Emergency Medicine
Cardiology
Female
France
Myocardial infarction diagnosis
Cardiology and Cardiovascular Medicine
business
Out-of-Hospital Cardiac Arrest
Follow-Up Studies
Zdroj: Resuscitation. 82:1148-1153
ISSN: 0300-9572
DOI: 10.1016/j.resuscitation.2011.04.023
Popis: Background Diagnosis of acute myocardial infarction (AMI) in out-of-hospital cardiac arrest (OHCA) patients is important because immediate coronary angiography with coronary angioplasty could improve outcome in this setting. However, the value of acute post-resuscitation electrocardiographic (ECG) data for the detection of AMI is debatable. Methods We assessed the diagnostic characteristics of post-resuscitation ECG changes in a retrospective single centre study evaluating several ECG criteria of selection of patients undergoing AMI, in order to improve sensitivity, even at the expense of specificity. Immediate post resuscitation coronary angiogram was performed in all patients. AMI was defined angiographically using coronary flow and plaque morphology criteria. Results We included 165 consecutive patients aged 56 (IQR 48–67) with sustained return of spontaneous circulation after OHCA between 2002 and 2008. 84 patients had shockable, 73 non-shockable and 8 unknown initial rhythm; 36% of the patients had an AMI. ST-segment elevation predicted AMI with 88% sensitivity and 84% specificity. The criterion including ST-segment elevation and/or depression had 95% sensitivity and 62% specificity. The combined criterion including ST-segment elevation and/or depression, and/or non-specific wide QRS complex and/or left bundle branch block provided a sensitivity and negative predictive value of 100%, a specificity of 46% and a positive predictive value of 52%. Conclusion In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion would detect all AMI and avoid the performance of the procedure in 30% of the patients, in whom coronary angiogram did not have a therapeutic role.
Databáze: OpenAIRE
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