Yonsei Med J.  2015 Jul;56(4):887-894. 10.3349/ymj.2015.56.4.887.

Combined ECG, Echocardiographic, and Biomarker Criteria for Diagnosing Acute Myocardial Infarction in Out-of-Hospital Cardiac Arrest Patients

• Lee SE
• Uhm JS
• Kim JY
• Pak HN
• Lee MH
• Joung B

• KMID: 2366326
• DOI: http://doi.org/10.3349/ymj.2015.56.4.887

Abstract

PURPOSE
Acute coronary lesions commonly trigger out-of-hospital cardiac arrest (OHCA). However, the prevalence of coronary artery disease (CAD) in Asian patients with OHCA and whether electrocardiogram (ECG) and other findings might predict acute myocardial infarction (AMI) have not been fully elucidated.
MATERIALS AND METHODS
Of 284 consecutive resuscitated OHCA patients seen between January 2006 and July 2013, we enrolled 135 patients who had undergone coronary evaluation. ECGs, echocardiography, and biomarkers were compared between patients with or without CAD.
RESULTS
We included 135 consecutive patients aged 54 years (interquartile range 45-65) with sustained return of spontaneous circulation after OHCA between 2006 and 2012. Sixty six (45%) patients had CAD. The initial rhythm was shockable and non-shockable in 110 (81%) and 25 (19%) patients, respectively. ST-segment elevation predicted CAD with 42% sensitivity, 87% specificity, and 65% accuracy. ST elevation and/or regional wall motion abnormality (RWMA) showed 68% sensitivity, 52% specificity, and 70% accuracy in the prediction of CAD. Finally, a combination of ST elevation and/or RWMA and/or troponin T elevation predicted CAD with 94% sensitivity, 17% specificity, and 55% accuracy.
CONCLUSION
In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion could detect 94% of CADs. However, compared with ECG only criteria, the combined criterion failed to improve diagnostic accuracy with a lower specificity.

Keyword

Cardiac arrest; myocardial infarction; electrocardiography; diagnosis

MeSH Terms

Aged
Biomarkers/*blood
Case-Control Studies
Coronary Angiography
Coronary Artery Disease/blood/*diagnosis/epidemiology
Echocardiography/*methods
Electrocardiography/*methods
Female
Humans
Male
Middle Aged
Myocardial Infarction/blood/*diagnosis/epidemiology
Out-of-Hospital Cardiac Arrest/*diagnosis
Sensitivity and Specificity
Troponin T
Biomarkers
Troponin T

Figure

• 

  Fig. 1 Flow chart of OHCA patients included in the study. CAD, coronary artery disease; CAG, coronary angiography; CCTA, coronary CT angiography; ECG, electrocardiogram; NSTEMI, non-ST-segment elevation myocardial infarction; OHCA, out-of-hospital cardiac arrest; PEA, pulseless electrical activity; ROSC, return of spontaneous circulation; STEMI, ST-segment elevation myocardial infarction; VF, ventricular fibrillation; VT, ventricular tachycardia.

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