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

Resuscitation. 2013 Sep;84(9):1250-4. doi: 10.1016/j.resuscitation.2013.04.023. Epub 2013 Apr 30.


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.

Keywords: Acute coronary lesions; Coronary artery disease; Electrocardiogram; Emergent coronary angiography; Out-of-hospital cardiac arrest.

MeSH terms

  • Acute Coronary Syndrome / diagnosis*
  • Acute Coronary Syndrome / epidemiology*
  • Acute Coronary Syndrome / therapy
  • Age Distribution
  • Aged
  • Angioplasty, Balloon, Coronary / methods
  • Angioplasty, Balloon, Coronary / mortality
  • Cardiopulmonary Resuscitation / methods
  • Cardiopulmonary Resuscitation / mortality
  • Cohort Studies
  • Comorbidity
  • Coronary Angiography / methods
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / therapy
  • Electrocardiography / methods*
  • Female
  • Hospital Mortality*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / diagnosis
  • Out-of-Hospital Cardiac Arrest / epidemiology*
  • Out-of-Hospital Cardiac Arrest / therapy
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Sex Distribution
  • Survival Analysis
  • Treatment Outcome