Authors: Garcia-Tejada J et al., Resuscitation 2014 Jun 11;
Patients with ST-segment elevation on post-arrest electrocardiogram were more likely to have acute coronary occlusion than those without it in a small study.
Determining which patients will benefit from urgent percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest is not always straightforward. These researchers assessed whether characteristics of the post-resuscitation electrocardiogram (ECG) aid in the decision. They retrospectively analyzed data from 84 adults with sustained return of spontaneous circulation after out-of-hospital cardiac arrest who underwent coronary angiography at a hospital in Spain during a 7-year period. Of these patients, 58% had ST-segment elevation on post-resuscitation ECG, and 42% had other patterns, including ST-segment depression, bundle branch block, and nonspecific ST-T wave changes.
Acute coronary artery occlusion was more frequent in patients with ST-segment elevation than in those without (83% vs. 8%), as was obstructive coronary artery disease (89% vs. 51%). In multivariate analyses, pre-arrest chest pain, shockable initial rhythm, and ST-segment elevation on post-resuscitation ECG were independent predictors of acute coronary occlusion. Absence of basic life support, prolonged resuscitation time, and vasopressor use were independent predictors of mortality or unfavorable neurological outcome at discharge.
These data may be skewed, because PCI was attempted more often in patients with ST-segment elevation than in those without. At present, there is no compelling reason to interpret an ECG for a post-arrest patient any differently than for a never-arrested patient in terms of the decision whether to proceed to emergent PCI.