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
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Publication date
2022-07-01
Authors
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
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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 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.
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
Citation
Spoormans, E M, Lemkes, J S, Janssens, G N, Soultana, O, van der Hoeven, N W, Jewbali, L S D, Dubois, E A, Meuwissen, M, Rijpstra, T A, Bosker, H A, Blans, M J, Bleeker, G B, Baak, R, Vlachojannis, G J, Eikemans, B J W, van der Harst, P, van der Horst, I C C, Voskuil, M, van der Heijden, J J, Beishuizen, A, Stoel, M, Camaro, C, van der Hoeven, H, Henriques, J P, Vlaar, A P J, Vink, M A, van den Bogaard, B, Heestermans, T A C M, de Ruijter, W, Delnoij, T S R, Crijns, H J G M, Oemrawsingh, P V, Gosselink, M T M, Plomp, K, Magro, M, Elbers, P W G, van de Ven, P M & van Royen, N 2022, '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', European heart journal. Acute cardiovascular care, vol. 11, no. 7, pp. 535-543. https://doi.org/10.1093/ehjacc/zuac060