Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study
Background Once the return of spontaneous circulation after out‐of‐hospital cardiac arrest is achieved, a 12‐lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features cou...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027923 |
| _version_ | 1797822365233577984 |
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| author | Francesca Romana Gentile Enrico Baldi Catherine Klersy Sebastian Schnaubelt Maria Luce Caputo Christian Clodi Jolie Bruno Sara Compagnoni Alessandro Fasolino Claudio Benvenuti Hans Domanovits Roman Burkart Roberto Primi Gerhard Ruzicka Michael Holzer Angelo Auricchio Simone Savastano |
| author_facet | Francesca Romana Gentile Enrico Baldi Catherine Klersy Sebastian Schnaubelt Maria Luce Caputo Christian Clodi Jolie Bruno Sara Compagnoni Alessandro Fasolino Claudio Benvenuti Hans Domanovits Roman Burkart Roberto Primi Gerhard Ruzicka Michael Holzer Angelo Auricchio Simone Savastano |
| author_sort | Francesca Romana Gentile |
| collection | DOAJ |
| description | Background Once the return of spontaneous circulation after out‐of‐hospital cardiac arrest is achieved, a 12‐lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30‐day survival in patients with out‐of‐hospital cardiac arrest. Methods and Results All the post‐return of spontaneous circulation ECGs from January 2015 to December 2018 in 3 European centers (Pavia, Lugano, and Vienna) were collected. Prehospital data were collected according to the Utstein style. A total of 370 ECGs were collected: 287 men (77.6%) with a median age of 62 years (interquartile range, 53–70 years). After correction for the return of spontaneous circulation‐to‐ECG time, age >62 years (hazard ratio [HR], 1.78 [95% CI, 1.21–2.61]; P=0.003), female sex (HR, 1.5 [95% CI, 1.05–2.13]; P=0.025), QRS wider than 120 ms (HR, 1.64 [95% CI, 1.43–1.87]; P<0.001), the presence of a Brugada pattern (HR, 1.49 [95% CI, 1.39–1.59]; P<0.001), and the presence of ST‐segment elevation in >1 segment (HR, 1.75 [95% CI, 1.59–1.93]; P<0.001) were independently associated with 30‐day mortality. A score ranging from 0 to 26 was created, and by dividing the population into 3 tertiles, 3 classes of risk were found with significantly different survival rate at 30 days (score 0–4, 73%; score 5–7, 66%; score 8–26, 45%). Conclusions The post‐return of spontaneous circulation ECG can identify patients who are at high risk of mortality after out‐of‐hospital cardiac arrest earlier than other forms of prognostication. This provides important risk stratification possibilities in postcardiac arrest care that could help to direct treatments and improve outcomes in patients with out‐of‐hospital cardiac arrest. |
| first_indexed | 2024-03-13T10:06:55Z |
| format | Article |
| id | doaj.art-e283941ab01b4b6f88207a9057d7d304 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-13T10:06:55Z |
| publishDate | 2023-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e283941ab01b4b6f88207a9057d7d3042023-05-22T11:34:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-05-01121010.1161/JAHA.122.027923Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE StudyFrancesca Romana Gentile0Enrico Baldi1Catherine Klersy2Sebastian Schnaubelt3Maria Luce Caputo4Christian Clodi5Jolie Bruno6Sara Compagnoni7Alessandro Fasolino8Claudio Benvenuti9Hans Domanovits10Roman Burkart11Roberto Primi12Gerhard Ruzicka13Michael Holzer14Angelo Auricchio15Simone Savastano16Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia ItalyDepartment of Molecular Medicine, Section of Cardiology University of Pavia Pavia ItalyClinical Epidemiology and Biometry Fondazione IRCCS Policlinico San Matteo Pavia ItalyDepartment of Emergency Medicine Medical University of Vienna Wien AustriaCardiocentro Ticino Lugano SwitzerlandDepartment of Emergency Medicine Medical University of Vienna Wien AustriaCardiocentro Ticino Lugano SwitzerlandDepartment of Molecular Medicine, Section of Cardiology University of Pavia Pavia ItalyDepartment of Molecular Medicine, Section of Cardiology University of Pavia Pavia ItalyFondazione Ticino Cuore Breganzona SwitzerlandClinical Epidemiology and Biometry Fondazione IRCCS Policlinico San Matteo Pavia ItalyFondazione Ticino Cuore Breganzona SwitzerlandDivision of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia ItalyDepartment of Emergency Medicine Medical University of Vienna Wien AustriaDepartment of Emergency Medicine Medical University of Vienna Wien AustriaCardiocentro Ticino Lugano SwitzerlandDivision of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia ItalyBackground Once the return of spontaneous circulation after out‐of‐hospital cardiac arrest is achieved, a 12‐lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30‐day survival in patients with out‐of‐hospital cardiac arrest. Methods and Results All the post‐return of spontaneous circulation ECGs from January 2015 to December 2018 in 3 European centers (Pavia, Lugano, and Vienna) were collected. Prehospital data were collected according to the Utstein style. A total of 370 ECGs were collected: 287 men (77.6%) with a median age of 62 years (interquartile range, 53–70 years). After correction for the return of spontaneous circulation‐to‐ECG time, age >62 years (hazard ratio [HR], 1.78 [95% CI, 1.21–2.61]; P=0.003), female sex (HR, 1.5 [95% CI, 1.05–2.13]; P=0.025), QRS wider than 120 ms (HR, 1.64 [95% CI, 1.43–1.87]; P<0.001), the presence of a Brugada pattern (HR, 1.49 [95% CI, 1.39–1.59]; P<0.001), and the presence of ST‐segment elevation in >1 segment (HR, 1.75 [95% CI, 1.59–1.93]; P<0.001) were independently associated with 30‐day mortality. A score ranging from 0 to 26 was created, and by dividing the population into 3 tertiles, 3 classes of risk were found with significantly different survival rate at 30 days (score 0–4, 73%; score 5–7, 66%; score 8–26, 45%). Conclusions The post‐return of spontaneous circulation ECG can identify patients who are at high risk of mortality after out‐of‐hospital cardiac arrest earlier than other forms of prognostication. This provides important risk stratification possibilities in postcardiac arrest care that could help to direct treatments and improve outcomes in patients with out‐of‐hospital cardiac arrest.https://www.ahajournals.org/doi/10.1161/JAHA.122.027923cardiac arrestECGpost‐ROSC care |
| spellingShingle | Francesca Romana Gentile Enrico Baldi Catherine Klersy Sebastian Schnaubelt Maria Luce Caputo Christian Clodi Jolie Bruno Sara Compagnoni Alessandro Fasolino Claudio Benvenuti Hans Domanovits Roman Burkart Roberto Primi Gerhard Ruzicka Michael Holzer Angelo Auricchio Simone Savastano Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac arrest ECG post‐ROSC care |
| title | Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study |
| title_full | Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study |
| title_fullStr | Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study |
| title_full_unstemmed | Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study |
| title_short | Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study |
| title_sort | association between postresuscitation 12 lead ecg features and early mortality after out of hospital cardiac arrest a post hoc subanalysis of the peace study |
| topic | cardiac arrest ECG post‐ROSC care |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027923 |
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