Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Apr 1;53(4):e916-e927.
doi: 10.1097/CCM.0000000000006619. Epub 2025 Feb 24.

Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality-A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial

Tharusan Thevathasan  1   2   3 , Julia Claus  4 , Michelle Roßberg  4 , Carsten Skurk  1   2   3 , Stephan Fichtlscherer  1   5 , Ibrahim Akin  1   6 , Georg Fuernau  7 , Christian Hassager  8   9 , Uwe Zeymer  10 , Michael R Preusch  1   11 , Tobias Graf  1   12 , Hans-Josef Feistritzer  4 , Alexander Jobs  1   4 , Suzanne de Waha  13 , Holger Thiele  1   4 , Steffen Desch  1   4 , Janine Pöss  4 , Anne Freund  1   4 ; Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality-A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial

Tharusan Thevathasan et al. Crit Care Med. .

Abstract

Objectives: The use of electrocardiograms for predicting significant coronary lesions and mortality in patients with successfully resuscitated out-of-hospital cardiac arrest (OHCA) without ST-segment elevation has not been defined yet. The objective of this study was to investigate the association and predictive value of various standardized 12-lead electrocardiogram patterns in patients with successfully resuscitated OHCA and no ST-segment elevations on the presence of significant coronary lesions (diagnostic performance) and 30-day mortality (prognostic performance).

Design: Predefined subanalysis of the Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) trial.

Setting: Multicenter, international randomized controlled trial across 31 centers.

Patients: Adult patients with successfully resuscitated OHCA and no ST-segment elevations.

Interventions: The first recorded electrocardiogram after the return of spontaneous circulation (ROSC) at hospital admission was analyzed by experienced physicians.

Measurements and main results: Significant coronary lesions and 30-day mortality. In total, 412 patients with a coronary angiography were included, of which 163 (40%) had significant coronary lesions. No electrocardiogram pattern was identified as a predictor of significant coronary lesions. In the total cohort of patients with and without coronary angiography, right bundle branch blocks (BBBs), prolonged intrinsicoid deflection times, and intrinsicoid deflections in right BBB were strong, independent predictors of 30-day mortality. The "intrinsicoid deflection" is the sharp upward deflection in the QRS complex of an electrocardiogram. The "intrinsicoid deflection time" is the interval from the start of the QRS complex to the peak of the R wave. The predictive performance for significant coronary lesions was poor across all electrocardiogram patterns and better for 30-day mortality.

Conclusions: Standardized 12-lead electrocardiogram patterns after ROSC at hospital admission in patients with successfully resuscitated OHCA without ST-segment elevations have poor predictive performance for the presence of significant coronary lesions. Different QRS-related patterns might identify patients with higher risk of short-term mortality.

Keywords: cardiac arrest; coronary lesion; electrocardiogram; mortality; prediction.

PubMed Disclaimer

Conflict of interest statement

Dr. Skurk received funding from Abiomed. Dr. Hassager received funding from BD; his institution received funding from the Novo Nordisk Foundation, the Lundbeck Foundation, and the Danish Heart Foundation. Dr. Preusch’s institution received funding for patient study documentation. Dr. Jobs received support for article research from the National Institutes of Health; he disclosed work for hire. Dr. Waha received funding from Zoll/TherOX. Dr. Pöss’ institution received funding from the German Cardiac Society, the German Heart Foundation, the Schwiete Foundation, and the Maquet Cardiopulmonary. Dr. Freund’s institution received funding from the German Center for Cardiovascular Research. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Smith A, Masters S, Ball S, et al.: The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis. Resuscitation. 2023; 185:109655
    1. Grunau B, Kime N, Leroux B, et al.: Association of intra-arrest transport vs continued on-scene resuscitation with survival to hospital discharge among patients with out-of-hospital cardiac arrest. JAMA. 2020; 324:1058–1067
    1. Geri G, Passouant O, Dumas F, et al.: Etiological diagnoses of out-of-hospital cardiac arrest survivors admitted to the intensive care unit: Insights from a French registry. Resuscitation. 2017; 117:66–72
    1. Dumas F, Cariou A, Manzo-Silberman S, et al.: Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: Insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry. Circ Cardiovasc Interv. 2010; 3:200–207
    1. 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

Publication types