Aim

A 12-lead electrocardiogram (ECG) after the return of spontaneous circulation (ROSC) is recommended to diagnose a ST-segment elevation myocardial infarction (STEMI). In the early post-ROSC phase, the ECG can show signs of ischemia not necessarily of coronary origin and post-ROSC hypoperfusion could affect ECG reliability. We sought for an association between peripheral perfusion index (PI) values after ROSC and the percentage of false-positive ECG for STEMI.

Methods

We considered all the consecutive patients with sustained ROSC after OHCA, admitted to the Fondazione IRCCS Policlinico San Matteo (Pavia) between January 1st, 2015 and December 31st, 2020. ECGs were defined false-positive if meeting the STEMI criteria but without a critical obstructive coronary artery disease worthy of treatment. The mean value of PI over 30 min-monitoring (MPI30) were calculated.

Results

Among 351 eligible patients post-ROSC ECG, PI monitoring and an invasive coronary angiography (ICA) were available in 84 cases. The rate of false positive was 16/54 (29.6%) and it differed significantly in the three MPI₃₀ tertiles [T1 (0.2–1): 28.6%; T2 (1.1–2.5): 24.1%; T3 (2.6–6.9): 3.7%, p = 0.04; p for trend = 0.02]. Cardiac arrest duration [OR 1.06 (95 %CI 1–1.1), p = 0.007] and MPI₃₀ [T3 vs T1: OR 0.09 (95 %CI 0.01–0.8), p = 0.03] were significantly associated with the probability of acquiring a false-positive ECG. This association was also confirmed when MPI₃₀ was adjusted for cardiac arrest duration [OR 0.2 (95 %CI 0.1–0.6), p=<0.001].

Conclusions

The rate of false-positive ECG for STEMI after ROSC is related with low perfusion. Our results could help to identify the adequate candidates for an immediate ICA.

中文翻译：

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院外心脏骤停患者ROSC后心电图外周灌注指数及诊断准确性

目的

建议在自主循环 (ROSC) 恢复后进行 12 导联心电图 (ECG) 来诊断 ST 段抬高型心肌梗死 (STEMI)。在 ROSC 后的早期阶段，心电图可以显示不一定是冠状动脉起源的缺血迹象，并且 ROC 后低灌注可能会影响心电图的可靠性。我们寻求 ROSC 后外周灌注指数 (PI) 值与 STEMI 假阳性 ECG 百分比之间的关联。

方法

我们考虑了在 2015 年 1 月 1 日至 2020 年 12 月 31 日期间入住 Fondazione IRCCS Policlinico San Matteo (Pavia) 的 OHCA 后持续 ROSC 的所有连续患者。如果符合 STEMI 标准但没有严重的阻塞性，则 ECG 被定义为假阳性值得治疗的冠状动脉疾病。计算超过 30 分钟监测 (MPI30) 的 PI 平均值。

结果

在 351 名符合条件的 ROSC 后心电图患者中，84 例可进行 PI 监测和侵入性冠状动脉造影 (ICA)。假阳性率为 16/54 (29.6%) 并且在三个 MPI ₃₀三分位数 [T1 (0.2–1): 28.6%; T2 (1.1–2.5)：24.1%；T3 (2.6–6.9)：3.7%，p = 0.04；趋势 p = 0.02]。心脏骤停持续时间 [OR 1.06 (95 %CI 1–1.1), p = 0.007] 和 MPI ₃₀ [T3 vs T1：OR 0.09 (95 %CI 0.01–0.8), p = 0.03] 与获得性概率显着相关假阳性心电图。当根据心脏骤停持续时间调整MPI ₃₀ [OR 0.2 (95 %CI 0.1–0.6), p=<0.001]时，也证实了这种关联。

结论

ROSC后STEMI的假阳性ECG率与低灌注有关。我们的结果可以帮助确定立即 ICA 的合适候选人。