TY - JOUR
T1 - Ischaemic electrocardiogram patterns and its association with survival in out-of-hospital cardiac arrest patients without ST-segment elevation myocardial infarction
T2 - a COACT trials' post-hoc subgroup analysis
AU - Spoormans, Eva M
AU - Lemkes, Jorrit S
AU - Janssens, Gladys N
AU - Soultana, Ouissal
AU - van der Hoeven, Nina W
AU - Jewbali, Lucia S D
AU - Dubois, Eric A
AU - Meuwissen, Martijn
AU - Rijpstra, Tom A
AU - Bosker, Hans A
AU - Blans, Michiel J
AU - Bleeker, Gabe B
AU - Baak, Remon
AU - Vlachojannis, Georgios J
AU - Eikemans, Bob J W
AU - van der Harst, Pim
AU - van der Horst, Iwan C C
AU - Voskuil, Michiel
AU - van der Heijden, Joris J
AU - Beishuizen, Albertus
AU - Stoel, Martin
AU - Camaro, Cyril
AU - van der Hoeven, Hans
AU - Henriques, José P
AU - Vlaar, Alexander P J
AU - Vink, Maarten A
AU - van den Bogaard, Bas
AU - Heestermans, Ton A C M
AU - de Ruijter, Wouter
AU - Delnoij, Thijs S R
AU - Crijns, Harry J G M
AU - Oemrawsingh, Pranobe V
AU - Gosselink, Marcel T M
AU - Plomp, Koos
AU - Magro, Michael
AU - Elbers, Paul W G
AU - van de Ven, Peter M
AU - van Royen, Niels
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2022/7/21
Y1 - 2022/7/21
N2 - 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 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.
AB - 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 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.
KW - Cardiac arrest
KW - ECG
KW - IMMEDIATE CORONARY-ANGIOGRAPHY
KW - Ischaemia
KW - Left ventricular function
KW - OUTCOMES
KW - POSTRESUSCITATION ELECTROCARDIOGRAMS
KW - PROGNOSIS
KW - Shockable rhythm
U2 - 10.1093/ehjacc/zuac060
DO - 10.1093/ehjacc/zuac060
M3 - Article
C2 - 35656797
SN - 2048-8726
VL - 11
SP - 535
EP - 543
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
IS - 7
ER -