335 Sensitivity and specificity of post-resuscitation ECG for the diagnosis of acute myocardial infarction in out-of-hospital cardiac arrests

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• 作者：Sebastian Voicu¹ ; Georgios Sideris¹ ; Jean Guillaume Dillinger¹ ; Nicolas Deye² ; Damien Logeart¹ ; Frederic Baud² ; Patrick Henry¹
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2010
• 出版时间：January 2010
• 年：2010
• 卷：2
• 期：1
• 页码：111
• 全文大小：73 K

文摘

Coronary angioplasty can decrease mortality in patients with acute myocardial infarction (AMI) and out-of-hospital cardiac arrest (OHCA). Sensitivity (Se) and specificity (Sp) of electrocardiogram (ECG) for AMI diagnosis in these patients are debated.

Purpose

to determine the Se and Sp of immediate post-resuscitation ECG for AMI diagnosis in patients resuscitated from an OHCA.

Methods

We screened in a prospective single centre study, 210 consecutive patients admitted for OHCA regardless of ECG abnormalities and medical history, between January 2002 and June 2008. All patients underwent coronary angiogram with angioplasty on arrival at the hospital. Exclusion criteria were: obvious non-cardiac cause of OHCA, age <18 or >90 years, unstable or absence of return of spontaneous circulation. AMI was characterized at angiography by a significant stenosis (>80 % lumen diameter) and TIMI 3 or 2 flow with intracoronary fresh thrombus, or TIMI 1 or 0 flow due to an occlusion easily crossed by a guide wire. Results are expressed as mean ¡À SD [range].

Results

Among the 170 patients included, 77 % were male and mean age was 58 ¡À 13 [26-90]. On post-resuscitation ECG, 41 % presented with ST segment elevation, 15 % with ST depression only (?mm), 12 % with large QRS complex only (>120 ms with left bundle branch block or atypical morphology), and 32 % with no significant ECG changes. AMI was diagnosed in 38 % of the patients: in 76 % of the patients with ST segment elevation, in 15 % with ST depression, in 15 % with large QRS, and in 0 % with none of the above. Se and Sp for AMI diagnosis of ST elevation, ST elevation or depression and ST elevation or depression or large QRS were 88 % and 83 % , 95 % and 63 % , 100 % and 46 % respectively.

Conclusion

ST elevation on ECG after a resuscitated OHCA has a moderate Se and Sp for AMI diagnosis. The combined criterion of ST elevation or depression or large QRS has 100 % sensitivity in our study and could identify all patients with AMI in the setting of OHCA.