Association of Timing of Electrocardiogram Acquisition after Return of Spontaneous Circulation with Coronary Angiography Findings in Patients with Out-of-Hospital Cardiac Arrest

Abstract

Importance: Electrocardiography (ECG) is an important tool to triage patients with out-of-hospital cardiac arrest (OHCA) after return of spontaneous circulation (ROSC). An immediate coronary angiography after ROSC is recommended only in patients with an ECG that is diagnostic of ST-segment elevation myocardial infarction (STEMI). To date, the benefit of this approach has not been demonstrated in patients with a post-ROSC ECG that is not diagnostic of STEMI. Objective: To assess whether the time from ROSC to ECG acquisition is associated with the diagnostic accuracy of ECG for STEMI. Design, Setting, and Participants: This retrospective, multicenter cohort study (the Post-ROSC Electrocardiogram After Cardiac Arrest study) analyzed consecutive patients older than 18 years who were resuscitated from OHCA between January 1, 2015, and December 31, 2018, and were admitted to 1 of the 3 participating centers in Europe (Pavia, Italy; Lugano, Switzerland; and Vienna, Austria). Exposure: Only patients who underwent coronary angiography during hospitalization and who acquired a post-ROSC ECG before the angiography were enrolled. Patients with a nonmedical cause of OHCAs were excluded. Main Outcomes and Measures: The primary end point was false-positive ECG findings, defined as the percentage of patients with post-ROSC ECG findings that met STEMI criteria but who did not show obstructive coronary artery disease on angiography that was worthy of percutaneous coronary angioplasty. Results: Of 586 consecutive patients who were admitted to the 3 participating centers, 370 were included in the analysis (287 men [77.6%]; median age, 62 years [interquartile range, 53-70 years]); 121 (32.7%) were enrolled in the participating center in Pavia, Italy; 38 (10.3%) in Lugano, Switzerland; and 211 (57.0%) in Vienna, Austria. The percentage of false-positive ECG findings in the first tertile of ROSC to ECG time (≤7 minutes) was significantly higher than that in the second (8-33 minutes) and third (>33 minutes) tertiles: 18.5% in the first tertile vs 7.2% in the second (odds ratio [OR], 0.34; 95% CI, 0.13-0.87; P =.02) and 5.8% in the third (OR, 0.27; 95% CI, 0.15-0.47; P 33 minutes: OR, 0.26; 95% CI, 0.14-0.47; P 33 minutes: OR, 0.27; 95% CI, 0.15-0.46; P 33 minutes: OR, 0.28; 95% CI, 0.15-0.52; P 33 minutes: OR, 0.27; 95% CI, 0.15-0.48; P 33 minutes: OR, 0.29; 95% CI, 0.15-0.55; P 33 minutes: OR, 0.27; 95% CI, 0.16-0.48; P 33 minutes: OR, 0.26; 95% CI, 0.15-0.46; P 33 minutes: OR, 0.27; 95% CI, 0.16-0.48; P