Combined ECG, echocardiographic, and biomarker criteria for diagnosing acute myocardial infarction in out-of-hospital cardiac arrest patients

Sang Eun Lee, Jae Sun Uhm, Jong Youn Kim, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)887-894
Number of pages8
JournalYonsei medical journal
Volume56
Issue number4
DOIs
Publication statusPublished - 2015 Jul 1

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Out-of-Hospital Cardiac Arrest
Electrocardiography
Biomarkers
Myocardial Infarction
Coronary Artery Disease
Sensitivity and Specificity
Troponin T
Echocardiography
Angiography

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{0ef3af33147d44b2b6316940870487a2,
title = "Combined ECG, echocardiographic, and biomarker criteria for diagnosing acute myocardial infarction in out-of-hospital cardiac arrest patients",
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.",
author = "Lee, {Sang Eun} and Uhm, {Jae Sun} and Kim, {Jong Youn} and Pak, {Hui Nam} and Lee, {Moon Hyoung} and Boyoung Joung",
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Combined ECG, echocardiographic, and biomarker criteria for diagnosing acute myocardial infarction in out-of-hospital cardiac arrest patients. / Lee, Sang Eun; Uhm, Jae Sun; Kim, Jong Youn; Pak, Hui Nam; Lee, Moon Hyoung; Joung, Boyoung.

In: Yonsei medical journal, Vol. 56, No. 4, 01.07.2015, p. 887-894.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Combined ECG, echocardiographic, and biomarker criteria for diagnosing acute myocardial infarction in out-of-hospital cardiac arrest patients

AU - Lee, Sang Eun

AU - Uhm, Jae Sun

AU - Kim, Jong Youn

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

PY - 2015/7/1

Y1 - 2015/7/1

N2 - 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.

AB - 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.

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