Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan.
Resuscitation. 2019 Sep;142:97-103. doi: 10.1016/j.resuscitation.2019.07.017. Epub 2019 Jul 19.
There is no simple clinical tool that reliably indicates the presence of acute coronary lesions in out-of-hospital cardiac arrest (OHCA) patients without typical ST-segment elevations. ST-segment elevation in electrocardiographic lead aVR suggests global subendocardial ischemia. This study aimed to evaluate the diagnostic value of lead aVR for identifying acute coronary lesions following resuscitation from OHCA.
A total of 74 patients without evidence of ST-segment elevations, who were resuscitated from OHCA, were examined. The degree of ST-segment elevation in lead aVR was measured directly after return of spontaneous circulation (ROSC) and at early follow-up. Coronary angiograms were retrospectively reviewed.
Acute coronary lesions were detected in 20 patients (27%). No difference in ST-segment elevation in lead aVR directly after ROSC was observed between patients with or without acute coronary lesions. However, ST-segment elevation values significantly decreased at early follow-up (median, 137 min) in patients without acute coronary lesions. An ST-segment elevation ≥0.5 mm in lead aVR at early follow-up was associated with a higher prevalence of multivessel coronary artery disease and was an independent indicator of the presence of acute coronary lesions (odds ratio, 4.41; 95% confidence interval, 1.12-17.4; p = 0.034).
ST-segment elevation in lead aVR at early follow-up was associated with the presence of acute lesions accompanied by severe coronary artery disease in post-cardiac arrest patients without other ST-segment elevations. The analysis of ST-segment elevation in lead aVR may aid in the identification of patients who will benefit from further invasive coronary diagnostic procedures.
目前尚无简单的临床工具能够可靠地指示院外心脏骤停（OHCA）患者中无典型 ST 段抬高的急性冠状动脉病变的存在。心电图导联 aVR 的 ST 段抬高提示全域心内膜下缺血。本研究旨在评估 aVR 导联在识别 OHCA 复苏后急性冠状动脉病变方面的诊断价值。
共检查了 74 例无 ST 段抬高证据的 OHCA 复苏患者。直接在自主循环恢复（ROSC）后和早期随访时测量 aVR 导联的 ST 段抬高程度。回顾性审查冠状动脉造影。
在 20 例（27%）患者中检测到急性冠状动脉病变。在有无急性冠状动脉病变的患者中，直接在 ROSC 后 aVR 导联的 ST 段抬高无差异。然而，在早期随访时（中位数 137 分钟），无急性冠状动脉病变患者的 ST 段抬高值显著下降。早期随访时 aVR 导联的 ST 段抬高≥0.5mm 与多支冠状动脉疾病的患病率较高相关，是急性冠状动脉病变存在的独立指标（比值比，4.41；95%置信区间，1.12-17.4；p=0.034）。
在无其他 ST 段抬高的心脏骤停后患者中，早期随访时 aVR 导联的 ST 段抬高与伴有严重冠状动脉疾病的急性病变有关。分析 aVR 导联的 ST 段抬高可能有助于识别那些将受益于进一步有创性冠状动脉诊断程序的患者。
