Diagnostic test accuracy of life-threatening electrocardiographic findings (ST-elevation myocardial infarction equivalents) for acute coronary syndrome after out-of-hospital cardiac arrest without ST-segment elevation

Satoshi Yoshimura; Takeyuki Kiguchi; Taro Irisawa; Tomoki Yamada; Kazuhisa Yoshiya; Changhwi Park; Tetsuro Nishimura; Takuya Ishibe; Hitoshi Kobata; Masafumi Kishimoto; Sung-Ho Kim; Yusuke Ito; Taku Sogabe; Takaya Morooka; Haruko Sakamoto; Keitaro Suzuki; Atsunori Onoe; Tasuku Matsuyama; Satoshi Matsui; Norihiro Nishioka; Yohei Okada; Yuto Makino; Shunsuke Kimata; Shunsuke Kawai; Ling Zha; Kosuke Kiyohara; Tetsuhisa Kitamura; Taku Iwami

doi:10.1016/j.resuscitation.2023.109700

Diagnostic test accuracy of life-threatening electrocardiographic findings (ST-elevation myocardial infarction equivalents) for acute coronary syndrome after out-of-hospital cardiac arrest without ST-segment elevation

Resuscitation. 2023 Mar:184:109700. doi: 10.1016/j.resuscitation.2023.109700. Epub 2023 Jan 23.

Authors

Satoshi Yoshimura¹, Takeyuki Kiguchi², Taro Irisawa³, Tomoki Yamada⁴, Kazuhisa Yoshiya⁵, Changhwi Park⁶, Tetsuro Nishimura⁷, Takuya Ishibe⁸, Hitoshi Kobata⁹, Masafumi Kishimoto¹⁰, Sung-Ho Kim¹¹, Yusuke Ito¹², Taku Sogabe¹³, Takaya Morooka¹⁴, Haruko Sakamoto¹⁵, Keitaro Suzuki¹⁶, Atsunori Onoe¹⁷, Tasuku Matsuyama¹⁸, Satoshi Matsui¹⁹, Norihiro Nishioka¹, Yohei Okada²⁰, Yuto Makino¹, Shunsuke Kimata¹, Shunsuke Kawai¹, Ling Zha¹⁹, Kosuke Kiyohara²¹, Tetsuhisa Kitamura¹⁹, Taku Iwami²²

Affiliations

¹ Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.
² Critical Care and Trauma Centre, Osaka General Medical Centre, Osaka, Japan.
³ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
⁴ Emergency and Critical Care Medical Centre, Osaka Police Hospital, Osaka, Japan.
⁵ Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan.
⁶ Department of Emergency Medicine, Tane General Hospital, Osaka, Japan.
⁷ Department of Critical Care Medicine, Osaka City University, Osaka, Japan.
⁸ Department of Emergency and Critical Care Medicine, Kindai University School of Medicine, Osaka-Sayama, Japan.
⁹ Osaka Mishima Emergency Critical Care Centre, Takatsuki, Japan.
¹⁰ Osaka Prefectural Nakakawachi Medical Centre of Acute Medicine, Higashi-Osaka, Japan.
¹¹ Senshu Trauma and Critical Care Centre, Osaka, Japan.
¹² Senri Critical Care Medical Centre, Saiseikai Senri Hospital, Suita, Japan.
¹³ Traumatology and Critical Care Medical Centre, National Hospital Organization Osaka National Hospital, Osaka, Japan.
¹⁴ Emergency and Critical Care Medical Centre, Osaka City General Hospital, Osaka, Japan.
¹⁵ Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan.
¹⁶ Emergency and Critical Care Medical Centre, Kishiwada Tokushukai Hospital, Osaka, Japan.
¹⁷ Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan.
¹⁸ Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁹ Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
²⁰ Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan; Health Services and Systems Research, Duke-NUS Medical School, Singapore.
²¹ Department of Food Science, Otsuma Women's University, Tokyo, Japan.
²² Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan. Electronic address: iwami.taku.8w@kyoto-u.ac.jp.

PMID: 36702338
DOI: 10.1016/j.resuscitation.2023.109700

Abstract

Aim: Life-threatening electrocardiographic (ECG) findings aid in the diagnosis of acute coronary syndrome (ACS), which has not been well-evaluated in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the diagnostic test accuracy (DTA) of ST-elevation myocardial infarction (STEMI) equivalents following the return of spontaneous circulation (ROSC) in patients with OHCA to identify patients with ACS.

Methods: Using the database of the Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival study from 2012 to 2017, patients aged ≥18 years with non-traumatic OHCA and ventricular fibrillation or pulseless ventricular tachycardia on the arrival of emergency medical service personnel or arrival at the emergency department, who achieved ROSC, were included. Patients without ST-segment elevation or complete left bundle branch block on ECG and those who did not undergo ECG or coronary angiography, were excluded from the study. We evaluated the DTA of STEMI equivalents for the diagnosis of ACS: isolated T-wave inversion, ST-segment depression, Wellens' signs, and ST-segment elevation in lead aVR.

Results: Isolated T-wave inversion and Wellens' signs had high specificity for ACS with 0.95 (95% confidence interval [CI], 0.87-0.99) and 0.92 (95% CI, 0.82-0.97), respectively, but their positive likelihood ratios were low, with a wide range of 95% CI: 1.89 (95% CI, 0.51-7.02) and 0.81 (95% CI, 0.25-2.68), respectively.

Conclusion: The DTA of STEMI equivalents for the diagnosis of ACS was low among patients with OHCA. Further investigation considering the measurement timing of the ECG after ROSC is required.

Keywords: Acute coronary syndrome; Electrocardiogram; Out-of-hospital cardiac arrest; STEMI equivalent.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Coronary Syndrome* / complications
Acute Coronary Syndrome* / diagnosis
Adolescent
Adult
Coronary Angiography
Diagnostic Tests, Routine
Electrocardiography
Humans
Out-of-Hospital Cardiac Arrest* / diagnosis
Out-of-Hospital Cardiac Arrest* / therapy
ST Elevation Myocardial Infarction* / complications
ST Elevation Myocardial Infarction* / diagnosis