The accuracy of an out-of-hospital 12-lead ECG for the detection of ST-elevation myocardial infarction immediately after resuscitation

Annals of Emergency Medicine
Dirk MüllerHans-Richard Arntz

Abstract

Severe myocardial ischemia is the leading cause of arrhythmic sudden cardiac death. It is unclear, however, in which percentage of patients sudden cardiac death is triggered by ST-elevation myocardial infarction (STEMI) and whether the diagnosis of STEMI can be reliably established immediately after resuscitation from out-of-hospital sudden cardiac death. A 12-lead ECG was registered after return of spontaneous circulation after cardiac arrest. After hospital admission, further ECG, creatine kinase MB, and troponin measures; results of coronary angiograms; and autopsies were evaluated to confirm the definitive diagnosis of STEMI. Seventy-seven patients were included in our study (67% men, age 64 [14 to 93] years). STEMI was diagnosed in 44 patients. The diagnosis of myocardial infarction was confirmed in 84% of the 77 patients who survived to hospital admission. The sensitivity of the out-of-hospital ECG was 88% (95% confidence interval [CI] 74% to 96%), the specificity 69% (95% CI 51% to 83%), the positive predictive value 77% (95% CI 62% to 87%), and the negative predictive value 83% (95% CI 64% to 87%). The accuracy of the out-of-hospital ECG and that registered on admission was the same. The diagnosis of STEMI can be establ...Continue Reading

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Citations

Sep 24, 2013·Best Practice & Research. Clinical Anaesthesiology·Nikolaos I Nikolaou, Apostolos H Christou
Jan 15, 2016·Herzschrittmachertherapie & Elektrophysiologie·Hans-Richard Arntz, Hans-Christian Mochmann
Oct 20, 2015·Resuscitation·Koenraad G MonsieursUNKNOWN ERC Guidelines 2015 Writing Group
Sep 23, 2016·Medizinische Klinik, Intensivmedizin und Notfallmedizin·H-C Mochmann
Apr 16, 2015·European Heart Journal. Acute Cardiovascular Care·Hilde E GrootErik Lipsic
Oct 8, 2013·Journal of the American Heart Association·James M McCabePeter Ganz
Oct 7, 2017·Cardiology in Review·Michael Goldfarb, Bojan Cercek
May 3, 2014·Current Opinion in Critical Care·Guillaume GeriAlain Cariou
Oct 26, 2018·Circulation. Cardiovascular Quality and Outcomes·David C LangeTimothy D Henry

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