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Clinical Trial
. 2022 Jul 21;11(7):535-543.
doi: 10.1093/ehjacc/zuac060.

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

Eva M Spoormans  1 , Jorrit S Lemkes  1 , Gladys N Janssens  1 , Ouissal Soultana  1 , Nina W van der Hoeven  1 , Lucia S D Jewbali  2 , Eric A Dubois  2   3 , Martijn Meuwissen  4 , Tom A Rijpstra  5 , Hans A Bosker  6 , Michiel J Blans  7 , Gabe B Bleeker  8 , Remon Baak  9 , Georgios J Vlachojannis  10   11 , Bob J W Eikemans  12 , Pim van der Harst  11   13 , Iwan C C van der Horst  14   15 , Michiel Voskuil  11 , Joris J van der Heijden  16 , Albertus Beishuizen  17 , Martin Stoel  18 , Cyril Camaro  19 , Hans van der Hoeven  20 , José P Henriques  21 , Alexander P J Vlaar  22 , Maarten A Vink  23 , Bas van den Bogaard  24 , Ton A C M Heestermans  25 , Wouter de Ruijter  26 , Thijs S R Delnoij  15 , Harry J G M Crijns  27 , Pranobe V Oemrawsingh  28 , Marcel T M Gosselink  29 , Koos Plomp  30 , Michael Magro  31 , Paul W G Elbers  32 , Peter M van de Ven  33 , Niels van Royen  1   19
Affiliations
Clinical Trial

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

Eva M Spoormans et al. Eur Heart J Acute Cardiovasc Care. .

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; ECG; Ischaemia; Left ventricular function; Shockable rhythm.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Kaplan–Meier estimates on 90-day survival. Patients with ischaemic electrocardiogram patterns had worse survival compared with patients without.
See this image and copyright information in PMC

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