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Diagnostic test accuracy of life-threatening electrocardiographic findings (ST-elevation myocardial infarction equivalents) for acute coronary syndrome after out-of-hospital cardiac arrest without ST-segment elevation

      Abstract

      Aim

      Life-threatening electrocardiographic (ECG) findings aid in the diagnosis of acute coronary syndrome (ACS), which has not been well-evaluated in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the diagnostic test accuracy (DTA) of ST-elevation myocardial infarction (STEMI) equivalents following the return of spontaneous circulation (ROSC) in patients with OHCA to identify patients with ACS.

      Methods

      Using the database of the Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival study from 2012 to 2017, patients aged ≥18 years with non-traumatic OHCA and ventricular fibrillation or pulseless ventricular tachycardia on the arrival of emergency medical service personnel or arrival at the emergency department, who achieved ROSC, were included. Patients without ST-segment elevation or complete left bundle branch block on ECG and those who did not undergo ECG or coronary angiography, were excluded from the study. We evaluated the DTA of STEMI equivalents for the diagnosis of ACS: isolated T-wave inversion, ST-segment depression, Wellens’ signs, and ST-segment elevation in lead aVR.

      Results

      Isolated T-wave inversion and Wellens’ signs had high specificity for ACS with 0.95 (95% confidence interval [CI], 0.87–0.99) and 0.92 (95% CI, 0.82–0.97), respectively, but their positive likelihood ratios were low, with a wide range of 95% CI: 1.89 (95% CI, 0.51–7.02) and 0.81 (95% CI, 0.25–2.68), respectively.

      Conclusion

      The DTA of STEMI equivalents for the diagnosis of ACS was low among patients with OHCA. Further investigation considering the measurement timing of the ECG after ROSC is required.

      Keywords

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      References

        • Tseng Z.H.
        • Olgin J.E.
        • Vittinghoff E.
        • et al.
        Prospective countywide surveillance and autopsy characterization of sudden cardiac death: POST SCD Study.
        Circulation. 2018; 137: 2689-2700
        • Perkins G.D.
        • Graesner J.-T.
        • Semeraro F.
        • et al.
        European resuscitation council guidelines 2021: executive summary.
        Resuscitation. 2021; 161: 1-60
        • Merchant R.M.
        • Topjian A.A.
        • Panchal A.R.
        • et al.
        Part 1: executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2020; 142: S337-S357
        • Stær-Jensen H.
        • Nakstad E.R.
        • Fossum E.
        • et al.
        Post-resuscitation ECG for selection of patients for immediate coronary angiography in out-of-hospital cardiac arrest.
        Circ Cardiovasc Interv. 2015; 8: e002784
        • Zanuttini D.
        • Armellini I.
        • Nucifora G.
        • et al.
        Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest.
        Resuscitation. 2013; 84: 1250-1254
        • Babken A.
        • Lukas V.
        • Negar M.
        Electrocardiographic diagnosis of life-threatening STEMI equivalents.
        JACC: Case Rep. 2019; 1: 666-668
        • Yamamoto M.
        • Witsch T.
        • Kubota S.
        • Hara H.
        • Hiroi Y.
        Diagnostic value of lead aVR in electrocardiography for identifying acute coronary lesions in patients with out-of-hospital cardiac arrest.
        Resuscitation. 2019; 142: 97-103
        • Kimura K.
        • Kimura T.
        • Ishihara M.
        • et al.
        JCS 2018 guideline on diagnosis and treatment of acute coronary syndrome.
        Circ J. 2019; 83: 1085-1196
        • Collet J.-P.
        • Thiele H.
        • Barbato E.
        • et al.
        2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.
        Eur Heart J. 2021; 42: 1289-1367
        • Baldi E.
        • Schnaubelt S.
        • Caputo M.L.
        • et al.
        Association of timing of electrocardiogram acquisition after return of spontaneous circulation with coronary angiography findings in patients with out-of-hospital cardiac arrest.
        JAMA Netw Open. 2021; 4: e2032875
        • Yamada T.
        • Kitamura T.
        • Hayakawa K.
        • et al.
        Rationale, design, and profile of Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan.
        J Intensive Care Med. 2016; 4: 1-10
        • Bossuyt P.M.
        • Reitsma J.B.
        • Bruns D.E.
        • et al.
        STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies.
        BMJ. 2015; 351h5527
      1. Communications MoIAa. Statistics Bureau of Japan (Accessed on 24 October 2022 at https://www.stat.go.jp/english/).

      2. Fire and Disaster Management Agency of the Ministry of Internal Affairs and Communications website (Accessed on 24 October 2022 at http://www.fdma.go.jp/neuter/topics/fieldList9_3.html).

        • Damman P.
        • Holmvang L.
        • Tijssen J.G.P.
        • et al.
        Usefulness of the admission electrocardiogram to predict long-term outcomes after non-ST-elevation acute coronary syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials).
        Am J Cardiol. 2012; 109: 6-12
        • Tan N.S.
        • Goodman S.G.
        • Yan R.T.
        • et al.
        Prognostic significance of low QRS voltage on the admission electrocardiogram in acute coronary syndromes.
        Int J Cardiol. 2015; 190: 34-39
        • Rhinehardt J.
        • Brady W.J.
        • Perron A.D.
        • Mattu A.
        Electrocardiographic manifestations of Wellens’ syndrome.
        Am J Emerg Med. 2002; 20: 638-643
        • Kosuge M.
        • Kimura K.
        Clinical implications of electrocardiograms for patients with non-ST-segment elevation acute coronary syndromes in the interventional era.
        Circ J. 2009; 73: 798-805
        • Engelen D.J.
        • Gorgels A.P.
        • Cheriex E.C.
        • et al.
        Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction.
        J Am Coll Cardiol. 1999; 34: 389-395
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • et al.
        Fourth universal definition of myocardial infarction (2018).
        Circulation. 2018; 138: e618-e651
        • Sideris G.
        • Voicu S.
        • Dillinger J.G.
        • et al.
        Value of post-resuscitation electrocardiogram in the diagnosis of acute myocardial infarction in out-of-hospital cardiac arrest patients.
        Resuscitation. 2011; 82: 1148-1153
        • Leclercq F.
        • Lonjon C.
        • Marin G.
        • et al.
        Post resuscitation electrocardiogram for coronary angiography indication after out-of-hospital cardiac arrest.
        Int J Cardiol. 2020; 310: 73-79