title: Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest.
abstract: BACKGROUND
  We aimed to investigate coronary angiographic findings in unselected out-of-hospital cardiac arrest patients referred to immediate coronary angiography (ICA) irrespective of their first postresuscitation ECG and to determine whether this ECG is useful to select patients with no need of ICA.
  
  
  RESULTS
  All resuscitated patients admitted after out-of-hospital cardiac arrest without a clear noncardiac cause underwent ICA. Patients were retrospectively grouped according to the postresuscitation ECG blinded for ICA results: (1) ST elevation or presumably new left bundle branch block, (2) other ECG signs indicating myocardial ischemia, and (3) no ECG signs indicating myocardial ischemia. All coronary angiograms were reevaluated blinded for postresuscitation ECGs. Two hundred and ten patients were included with mean age 62±12 years. Six-months survival with good neurological outcome was 54%. Reduced Thrombolysis in Myocardial Infarction flow (0-2) was found in 55%, 34%, and 18% and a ≥90% coronary stenosis was present in 25%, 27%, and 19% of patients in group 1, 2, and 3, respectively. An acute coronary occlusion was found in 11% of patients in group 3. ST elevation/left bundle branch block identified patients with reduced Thrombolysis in Myocardial Infarction (0-2) flow with 70% sensitivity and 62% specificity. Among patients with initial nonshockable rhythms (24%), 32% had significantly reduced Thrombolysis in Myocardial Infarction flow.
  
  
  CONCLUSIONS
  Initial ECG findings are not reliable in detecting patients with an indication for ICA after experiencing a cardiac arrest. Even in the absence of ECG changes indicating myocardial ischemia, an acute culprit lesion may be present and patients may benefit from emergent revascularization. CLINICAL TRIAL REGISTRATIONURL: http://www.clinicaltrials.gov. Unique identifier: NCT01239420.
authors.affiliation: From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway. uxshph@ous-hf.no.
authors.forename: Henrik
authors.initials: H
authors.lastname: Stær-Jensen
authors.affiliation: From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway.
authors.forename: Espen Rostrup
authors.initials: ER
authors.lastname: Nakstad
authors.affiliation: From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway.
authors.forename: Eigil
authors.initials: E
authors.lastname: Fossum
authors.affiliation: From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway.
authors.forename: Arild
authors.initials: A
authors.lastname: Mangschau
authors.affiliation: From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway.
authors.forename: Jan
authors.initials: J
authors.lastname: Eritsland
authors.affiliation: From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway.
authors.forename: Tomas
authors.initials: T
authors.lastname: Drægni
authors.affiliation: From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway.
authors.forename: Dag
authors.initials: D
authors.lastname: Jacobsen
authors.affiliation: From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Sunde
authors.affiliation: From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway.
authors.forename: Geir Øystein
authors.initials: GØ
authors.lastname: Andersen
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D009664:Norway; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D018579:Patient Selection; D011446:Prospective Studies; D012151:Resuscitation; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: cardiac arrest; coronary angiography; coronary artery disease; coronary occlusion; post-ROSC ECG