Normal Electrocardiogram Following Resuscitation for An Out of Hospital Cardiac Arrest is not a Deterrent for Urgent Coronary Angiography

Abstract

Background: Acute coronary syndrome is the most common cause of an out of hospital cardiac arrest (OOHCA). Currently, controversy surrounds the diagnostic utility of conventional electrophysiological criteria used in the non-arrested population to guide decision making for early coronary intervention. Methods and Results: This was a retrospective, single tertiary centre study observing the initial ECG of all patients resuscitated following an OOHCA. Patients were grouped according to the findings on the post-resusitation ECG: (1) ST elevation (2) ST depression (3) left bundle branch block (LBBB), and (4) no ECG features of ischaemia (normal ECG). 160 patients were included with average age of 62.6 years. A culptrit vessel occlusion or significant stenosis was present in 56%, 52%, 58% and 44% in groups 1-4, respectively. In the selected group with an initial shockable rhythm, a cultprit lesion was present in 19% of patients in group 4. ST-elevation predicted a culptrit lesion in the VF cohort with 61% sensitivity, 75% specificity and positive predictive value of 50%. A normal ECG predicted minor coronary disease or less with 36% sensitivity, 78% specificity and a negative predictive value of 73%. Conclusion: The post resuscitation ECG is not a reliable tool to guide the decision for coronary angiography as an acute culprit lesion was seen in one in five patients with a normal ECG.