P1700Atrial fibrillation with CRBBB highly predict hospital mortality in the AMI patients presenting with out-of-hospital cardiac arrest after return of spontaneous circulation

Abstract

Abstract Approximately 70% of survivals of out-of-hospital cardiac arrest (OHCA) have coronary artery disease, with acute vessel occlusion observed in 50%. The use of ECG to predict mortality and neurological outcomes in acute myocardial infarction (AMI) patients successfully resuscitated for OHCA has not been well-determined. Between May, 2016 and July, 2018, 1428 consecutive patients with OHCA visited the emergency department of Far Eastern Memorial Hospital, New Taipei City, Taiwan. A total number of 117 patients with return-of-spontaneous-circulation (ROSC) were diagnosed of AMI, mostly confirmed by coronary angiography. The mean age was 60.0±13.6 (mean SD) with male gender 105/117. Endpoint was mortality in hospital. The hospital mortality rate was 44.4%. Wide QRS duration (>120ms; 48.1%), complete right bundle branch block (33.3%) and atrial fibrillation (59.3%) occurred frequently in the first ECG of post-rescuscitation patients. Patient with wide QRS duration (correlation coefficient, CC: 0.350; p=0.074) and atrial fibrillation (CC: 0.287; p=0.147) had a trend towards higher mortality rate. Complete right bundle branch block (CRBBB) on the first ECG post resuscitation (CC: 0.632; p<0.001) and ST depression on first ECG post resuscitation (CC: 0.481; p=0.011) were associated with worse outcome (Mortality). Shockable rhythm (Ventricular tachycardia or fibrillation) during CPR (CC: −0.635; p<0.001), and sinus rhythm on first ECG (CC: −0.474; p=0.012) were associated better outcome (survival and neurological recovery). The combination two ECG characteristics of atrial fibrillation and CRBBB on the first ECG post resuscitation was highly associated with in-hospital mortality (CC: 0.725; p<0.001). It had a 66.7% sensitivity, 93.3% specificity, 88.9% positive predictive value, and 78.9% negative predictive value for predicting mortality. In conclusion, atrial fibrillation with CRBBB on the first ECG post resuscitation is the best predictors for unfavorable neurological outcome and mortality.