Editor’s Choice-Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?

Salam, Idrees; Hassager, Christian; Thomsen, Jakob Hartvig; Langkjær, Sandra; Søholm, Helle; Bro-Jeppesen, John; Bang, Lia E.; Holmvang, Lene; Erlinge, David; Wanscher, Michael; Lippert, Freddy; Køber, Lars; Kjærgaard, Jesper

doi:10.1177/2048872615585519

Cited by 24 publications

(12 citation statements)

References 34 publications

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“…3,4 One factor contributing to the varied range in the incidence of CS after STEMI is the prevalence of OHCA, as electrocardiographic changes immediately after resuscitation are difficult to interpret for diagnosing STEMI. 21 This study suggests that the prevalence of OHCA in AMICS is increasing and is in agreement with the recent CULPRIT-SHOCK trial where > 50% of patients had sustained cardiac arrest before randomisation. 10,22 We observed that patients with AMICS and OHCA undergoing revascularization had lower 30-day mortality than patients without OHCA (6% absolute reduction in mortality).…”

Section: Discussionsupporting

confidence: 90%

“…The incidence of CS in patients with STEMI varies in the literature as studies show both increasing and declining trends over time, but is typically reported to range between 5% and 10% . One factor contributing to the varied range in the incidence of CS after STEMI is the prevalence of OHCA, as electrocardiographic changes immediately after resuscitation are difficult to interpret for diagnosing STEMI . This study suggests that the prevalence of OHCA in AMICS is increasing and is in agreement with the recent CULPRIT‐SHOCK trial where > 50% of patients had sustained cardiac arrest before randomisation .…”

Section: Discussionsupporting

confidence: 84%

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Temporal trends in incidence and patient characteristics in cardiogenic shock following acute myocardial infarction from 2010 to 2017: a Danish cohort study

Helgestad

Josiassen

Hassager

et al. 2019

European J of Heart Fail

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122

132

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Aim We sought to describe the contemporary annual incidence of cardiogenic shock (CS) following acute myocardial infarction (AMICS), the proportion of patients developing CS following ST‐elevation myocardial infarction (STEMI), and other temporal changes in AMICS in Denmark between 2010 and 2017. Methods and results Medical records of patients suspected of having AMICS during 2010–2017 were reviewed to identify consecutive patients with AMICS in a cohort corresponding to two‐thirds of the Danish population. Due to changes in recruitment area over the study period, population‐based incidence could only be calculated from 2012 to 2017. A total of 1716 patients with AMICS were identified and an increase in the annual incidence was observed, from a nadir 65.3 per million person‐years in 2013 to 80.0 per million person‐years in 2017 (P‐value for trend < 0.001). This trend corresponded to an increase in patients with non‐STEMI and a decrease in patients developing CS after STEMI (10.0–6.6%, P‐value for trend < 0.001) Also, mean arterial blood pressure at the time of AMICS was lower (63 ± 11 mmHg to 61 ± 13 mmHg, P‐value for trend = 0.001) and the frequency of patients with left ventricular ejection fraction ≤ 30% increased (61.8%–71.4%, P‐value for trend = 0.004). The annual 30‐day mortality during the study period remained unchanged at about 50%. Conclusion The incidence rate of AMICS increased in the Danish population between 2012 and 2017. Fewer patients with STEMI developed CS, and haemodynamic severity of CS increased during the study period; however, survival rates remained unchanged.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 84%

Temporal trends in incidence and patient characteristics in cardiogenic shock following acute myocardial infarction from 2010 to 2017: a Danish cohort study

Helgestad

Josiassen

Hassager

et al. 2019

European J of Heart Fail

Self Cite

122

132

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“…The issue is further complicated by difficulties interpreting symptoms as well as the ECG in the post cardiac arrest setting since the post resuscitation ECG seem to be a poor predictor of an acute coronary occlusion [8,9]. No randomized trials have evaluated the potential benefit of immediate coronary angiography in patients without STEMI and register studies have shown diverging results [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest – A targeted temperature management (TTM) trial substudy

et al. 2016

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High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest -A targeted temperature management (TTM) trial substudyGilje, Patrik; Koul, Sasha; Thomsen, Jakob Hartvig; Devaux, Yvan; Friberg, Hans; Kuiper, Michael; Horn, Janneke; Nielsen, Niklas; Pellis, Tomasso; Stammet, Pascal; Wise, Matthew P.; Kjaergaard, Jesper; Hassager, Christian; Erlinge, David Link to publication Citation for published version (APA): Gilje, P., Koul, S., Thomsen, J. H., Devaux, Y., Friberg, H., Kuiper, M., ... Erlinge, D. (2016). High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest -A targeted temperature management (TTM) trial substudy. Resuscitation, 107, 156-161. DOI: 10.1016/j.resuscitation.2016 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Predicting outcome of unconscious patients after successful resuscitation is challenging and better prognostic markers are highly needed. Ischemic heart disease is a common cause of out-of-hospital cardiac arrest (OHCA).Whether or not high-sensitivity troponin T (hs-TnT) is a prognostic marker among survivors of OHCA with both ischemic and non-ischemic aetiologies remains to be determined. We sought to evaluate the ability of hs-TnT to prognosticate all-cause mortality, death due to cardiovascular causes or multi-organ failure and death due to cerebral causes after OHCA. The influence of the level of target temperature management on hs-TnT as a marker of infarct size was also assessed. Methods:A total of 699 patients from the Targeted Temperature Management (TTM) trial were included and hs-TnT was analysed in blood samples from 24, 48 and 72 h after return of spontaneous circulation (ROSC). The endpoints were 180 day all-cause mortality, death due to cardiovascular causes or multi-organ failure and death due to cerebral causes. Subgroups based on the initial ECG after ROSC (STEMI vs all other ECG presentations) were analysed. Results:Hs-TnT was independently associated with all-cause mortality which was driven by death due to cardiovascular causes or multi-organ failure and not cerebral causes (at 48h: OR 1.10, CI 1.01-1.20, p<0.05). Hs-TnT was also an independent predictor of death due to cardiovascular causes or multi-organ failure (at 48h: OR 1.13, CI 1.01-1.26, p<0.05). In patients with STEMI, hs-TnT was independently associated with death due to cardiovascular causes or multi-organ failure (at 48h: OR 1.47, CI 1.10-1.95, p<0.01). Targeted temperature management at 33 °C was not ...

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“…If the cause of cardiac arrest is ST-elevation acute myocardial infarction (STEMI), immediate coronary angiography (CAG) with/without PCI is recommended. Even for non-STEMI that induces cardiac arrest, CAG with/ without PCI is recommended, because prehospital electrocardiography does not identify an occluded coronary artery [38], and a previous study found that 25% of patients with non-STEMI had an occluded coronary artery [39]. Although Lemkes et al [40] recently reported that a strategy involving immediate CAG was not found to be better than delayed CAG for PCAS patients who had no signs of STEMI, the relatively lower severity of the patients included was pointed out as a research limitation [41].…”

Section: Treatment For Myocardial Dysfunctionmentioning

confidence: 99%

Targeted temperature management for postcardiac arrest syndrome

Kuroda

Kawakita

2020

J Neurocrit Care

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Neurocritical care management to improve neurologic outcome for postcardiac arrest syndrome (PCAS) has focused considerably on targeted temperature management (TTM). TTM attenuates the destructive processes following ischemia/reperfusion in PCAS. The principal indication of TTM is a patient with sustained coma after return of spontaneous circulation (ROSC). TTM can be strongly recommended with a target temperature between 32°C and 36°C for patients with shockable rhythm and out-of-hospital cardiac arrest (OHCA) and weakly recommended for patients with initial asystole or pulseless electrical activity with OHCA and those with in-hospital cardiac arrest. TTM is induced and maintained using a cooling device with body temperature feedback under appropriate analgosedation. It requires the intensive management of various systemic respiratory, circulatory, and metabolic parameters that control shivering to prevent secondary brain damage. Considering the cerebral perfusion pressure, it is suggested that the mean arterial pressure should be particularly maintained over 80 mm Hg. Seizure management, including continuous electroencephalography monitoring, is also needed. Finally, we must continue the above mentioned care during and after the rewarming phase, because high fever and shivering may appear again during this period. Furthermore, neurological prognostication should be performed at least 72 hours after ROSC through clinical investigations and multimodal testing without sedation.

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Editor’s Choice-Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?

Cited by 24 publications

References 34 publications

Temporal trends in incidence and patient characteristics in cardiogenic shock following acute myocardial infarction from 2010 to 2017: a Danish cohort study

Temporal trends in incidence and patient characteristics in cardiogenic shock following acute myocardial infarction from 2010 to 2017: a Danish cohort study

High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest – A targeted temperature management (TTM) trial substudy

Targeted temperature management for postcardiac arrest syndrome

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