Abstract
Out-of-hospital cardiac arrest (OHCA) remains a major threat to public health worldwide. OHCA patients presenting initial shockable ventricular tachycardia/ventricular fibrillation (VT/VF) rhythm have a better survival rate. We sought to develop a simple SACAF score to discriminate VT/VF from non-VT/VF OHCAs based on the Taiwan multicenter hospital-based registry database. We analyzed the in- and pre-hospital data, including demographics, baseline comorbidities, response times, automated external defibrillator information, and the 12-lead ECG recording closest to the OHCA event in bystander-witnessed OHCA patients. Among the 461 study patients, male sex (OR 2.54, 95% CI = 1.32–4.88, P = 0.005), age ≤ 65 years (OR 2.78, 95% CI = 1.64–4.70, P < 0.001), cardiovascular diseases (OR 2.97, 95% CI = 1.73–5.11, P < 0.001), and atrial fibrillation (AF) (OR 2.36, 95% CI = 1.17–4.76, P = 0.017) were independent risk factors for VT/VF OHCA (n = 81) compared with non-VT/VF OHCA (n = 380). A composite SACAF score was developed (male Sex, Age ≤ 65 years, Cardiovascular diseases, and AF) and compared with the performance of a modified CHA2DS2-VASc score (Cardiovascular diseases, Hypertension, Age ≥ 75 years, Diabetes, previous Stroke, Vascular disease, Age 65–74 years, female Sex category). The area under the receiver operating characteristic curve (AUC) of the SACAF was 0.739 (95% CI = 0.681–0.797, P < 0.001), whereas the AUC of the modified CHA2DS2-VASc was 0.474 (95% CI = 0.408–0.541, P = 0.464). A SACAF score of ≥ 2 was useful in discriminating VT/VF from non-VT/VF OHCAs with a sensitivity of 0.75 and a specificity of 0.60. In conclusion, the simple SACAF score appears to be useful in discriminating VT/VF from non-VT/VF bystander-witnessed OHCAs and the findings may also shed light on future mechanistic evaluation.
Highlights
Out-of-hospital cardiac arrest (OHCA), accounting for up to 50% of all cardiovascular deaths, remains a major threat to public health w orldwide[1]
In a prospective cohort study of OHCA in adults from 10 North American communities, Weisfeldt et al showed that younger age and male sex were independently associated with initial VT/VF in both bystander-witnessed arrests and emergency medical services (EMS)-witnessed arrests[11]
After excluding patients with incomplete demographic data (n = 3) or no 12-lead ECG records before OHCA events (n = 347), a total of 461 patients were included in the analysis
Summary
Out-of-hospital cardiac arrest (OHCA), accounting for up to 50% of all cardiovascular deaths, remains a major threat to public health w orldwide[1]. Nof et al demonstrated that a high CHA2DS2-VASc score was inversely associated with VT/VF events in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT)[22] With this background information, we were motivated to conduct a multicenter study to identify the risk factors for initial VT/VF by analyzing the demographics, comorbidities, and ECG parameters in witnessed OHCA patients from 5 tertiary-care medical centers in Taiwan. We were motivated to conduct a multicenter study to identify the risk factors for initial VT/VF by analyzing the demographics, comorbidities, and ECG parameters in witnessed OHCA patients from 5 tertiary-care medical centers in Taiwan With this approach, we sought to develop a useful scoring tool to effectively predict VT/ VF OHCA. The ultimate goal was to better understand the regional risk factors for VT/VF OHCA and to pave the way for implementing evidence-based preventive management for VT/VF OHCA patients in this region
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