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

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

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Aims: Acute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). Aim of the present study was to assess the predictive value of ST-segment changes in diagnosing the presence of acute coronary lesions among OHCA patients. Methods: Findings of coronary angiography (CA) performed in patients resuscitated from OCHA were retrospectively reviewed and related to ST-segment changes on post-ROSC electrocardiogram (ECG). Results: Ninety-one patients underwent CA after OHCA; 44% of patients had ST-segment elevation and 56% of patients had other ECG patterns on post-ROSC ECG. Significant coronary artery disease (CAD) was found in 86% of patients; CAD was observed in 98% of patients with ST-segment elevation and in 77% of patients with other ECG patterns on post-ROSC ECG (p= 0.004). Acute or presumed recent coronary artery lesions were diagnosed in 56% of patients, respectively in 85% of patients with ST-segment elevation and in 33% of patients with other ECG patterns (p<. 0.001). ST-segment analysis on post-ROSC ECG has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (85% and 67%, respectively). Conclusions: Electrocardiographic findings after OHCA should not be considered as strict selection criteria for performing emergent CA in patients resuscitated from OHCA without obvious extra-cardiac cause; even in the absence of ST-segment elevation on post-ROSC ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest.

LanguageEnglish
Pages1250-1254
Number of pages5
JournalResuscitation
Volume84
Issue number9
DOIs
Publication statusPublished - Sep 2013

Keywords

  • Acute coronary lesions
  • Coronary artery disease
  • Electrocardiogram
  • Emergent coronary angiography
  • Out-of-hospital cardiac arrest

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Zanuttini, D., Armellini, I., Nucifora, G., Grillo, M. T., Morocutti, G., Carchietti, E., ... Proclemer, A. (2013). Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest. Resuscitation, 84(9), 1250-1254. https://doi.org/10.1016/j.resuscitation.2013.04.023
Zanuttini, Davide ; Armellini, Ilaria ; Nucifora, Gaetano ; Grillo, Maria Teresa ; Morocutti, Giorgio ; Carchietti, Elio ; Trillò, Giulio ; Spedicato, Leonardo ; Bernardi, Guglielmo ; Proclemer, Alessandro. / Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest. In: Resuscitation. 2013 ; Vol. 84, No. 9. pp. 1250-1254.
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title = "Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest",
abstract = "Aims: Acute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). Aim of the present study was to assess the predictive value of ST-segment changes in diagnosing the presence of acute coronary lesions among OHCA patients. Methods: Findings of coronary angiography (CA) performed in patients resuscitated from OCHA were retrospectively reviewed and related to ST-segment changes on post-ROSC electrocardiogram (ECG). Results: Ninety-one patients underwent CA after OHCA; 44{\%} of patients had ST-segment elevation and 56{\%} of patients had other ECG patterns on post-ROSC ECG. Significant coronary artery disease (CAD) was found in 86{\%} of patients; CAD was observed in 98{\%} of patients with ST-segment elevation and in 77{\%} of patients with other ECG patterns on post-ROSC ECG (p= 0.004). Acute or presumed recent coronary artery lesions were diagnosed in 56{\%} of patients, respectively in 85{\%} of patients with ST-segment elevation and in 33{\%} of patients with other ECG patterns (p<. 0.001). ST-segment analysis on post-ROSC ECG has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (85{\%} and 67{\%}, respectively). Conclusions: Electrocardiographic findings after OHCA should not be considered as strict selection criteria for performing emergent CA in patients resuscitated from OHCA without obvious extra-cardiac cause; even in the absence of ST-segment elevation on post-ROSC ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest.",
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Zanuttini, D, Armellini, I, Nucifora, G, Grillo, MT, Morocutti, G, Carchietti, E, Trillò, G, Spedicato, L, Bernardi, G & Proclemer, A 2013, 'Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest', Resuscitation, vol. 84, no. 9, pp. 1250-1254. https://doi.org/10.1016/j.resuscitation.2013.04.023

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.

In: Resuscitation, Vol. 84, No. 9, 09.2013, p. 1250-1254.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest

AU - Zanuttini, Davide

AU - Armellini, Ilaria

AU - Nucifora, Gaetano

AU - Grillo, Maria Teresa

AU - Morocutti, Giorgio

AU - Carchietti, Elio

AU - Trillò, Giulio

AU - Spedicato, Leonardo

AU - Bernardi, Guglielmo

AU - Proclemer, Alessandro

PY - 2013/9

Y1 - 2013/9

N2 - Aims: Acute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). Aim of the present study was to assess the predictive value of ST-segment changes in diagnosing the presence of acute coronary lesions among OHCA patients. Methods: Findings of coronary angiography (CA) performed in patients resuscitated from OCHA were retrospectively reviewed and related to ST-segment changes on post-ROSC electrocardiogram (ECG). Results: Ninety-one patients underwent CA after OHCA; 44% of patients had ST-segment elevation and 56% of patients had other ECG patterns on post-ROSC ECG. Significant coronary artery disease (CAD) was found in 86% of patients; CAD was observed in 98% of patients with ST-segment elevation and in 77% of patients with other ECG patterns on post-ROSC ECG (p= 0.004). Acute or presumed recent coronary artery lesions were diagnosed in 56% of patients, respectively in 85% of patients with ST-segment elevation and in 33% of patients with other ECG patterns (p<. 0.001). ST-segment analysis on post-ROSC ECG has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (85% and 67%, respectively). Conclusions: Electrocardiographic findings after OHCA should not be considered as strict selection criteria for performing emergent CA in patients resuscitated from OHCA without obvious extra-cardiac cause; even in the absence of ST-segment elevation on post-ROSC ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest.

AB - Aims: Acute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). Aim of the present study was to assess the predictive value of ST-segment changes in diagnosing the presence of acute coronary lesions among OHCA patients. Methods: Findings of coronary angiography (CA) performed in patients resuscitated from OCHA were retrospectively reviewed and related to ST-segment changes on post-ROSC electrocardiogram (ECG). Results: Ninety-one patients underwent CA after OHCA; 44% of patients had ST-segment elevation and 56% of patients had other ECG patterns on post-ROSC ECG. Significant coronary artery disease (CAD) was found in 86% of patients; CAD was observed in 98% of patients with ST-segment elevation and in 77% of patients with other ECG patterns on post-ROSC ECG (p= 0.004). Acute or presumed recent coronary artery lesions were diagnosed in 56% of patients, respectively in 85% of patients with ST-segment elevation and in 33% of patients with other ECG patterns (p<. 0.001). ST-segment analysis on post-ROSC ECG has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (85% and 67%, respectively). Conclusions: Electrocardiographic findings after OHCA should not be considered as strict selection criteria for performing emergent CA in patients resuscitated from OHCA without obvious extra-cardiac cause; even in the absence of ST-segment elevation on post-ROSC ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest.

KW - Acute coronary lesions

KW - Coronary artery disease

KW - Electrocardiogram

KW - Emergent coronary angiography

KW - Out-of-hospital cardiac arrest

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