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

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) tria...

Descripción completa

Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Original Scientific Paper
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302930/
https://www.ncbi.nlm.nih.gov/pubmed/35656797
http://dx.doi.org/10.1093/ehjacc/zuac060
Descripción
Sumario: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.

Ejemplares similares