Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Resuscitation. 2021 Nov;168:19-26. doi: 10.1016/j.resuscitation.2021.08.050. Epub 2021 Sep 8.
A 12-lead electrocardiogram (ECG) after the return of spontaneous circulation (ROSC) is recommended to diagnose a ST-segment elevation myocardial infarction (STEMI). In the early post-ROSC phase, the ECG can show signs of ischemia not necessarily of coronary origin and post-ROSC hypoperfusion could affect ECG reliability. We sought for an association between peripheral perfusion index (PI) values after ROSC and the percentage of false-positive ECG for STEMI.
We considered all the consecutive patients with sustained ROSC after OHCA, admitted to the Fondazione IRCCS Policlinico San Matteo (Pavia) between January 1st, 2015 and December 31st, 2020. ECGs were defined false-positive if meeting the STEMI criteria but without a critical obstructive coronary artery disease worthy of treatment. The mean value of PI over 30 min-monitoring (MPI30) were calculated.
Among 351 eligible patients post-ROSC ECG, PI monitoring and an invasive coronary angiography (ICA) were available in 84 cases. The rate of false positive was 16/54 (29.6%) and it differed significantly in the three MPI tertiles [T1 (0.2-1): 28.6%; T2 (1.1-2.5): 24.1%; T3 (2.6-6.9): 3.7%, p = 0.04; p for trend = 0.02]. Cardiac arrest duration [OR 1.06 (95 %CI 1-1.1), p = 0.007] and MPI [T3 vs T1: OR 0.09 (95 %CI 0.01-0.8), p = 0.03] were significantly associated with the probability of acquiring a false-positive ECG. This association was also confirmed when MPI was adjusted for cardiac arrest duration [OR 0.2 (95 %CI 0.1-0.6), p=<0.001].
The rate of false-positive ECG for STEMI after ROSC is related with low perfusion. Our results could help to identify the adequate candidates for an immediate ICA.
建议在自主循环恢复（ROSC）后进行 12 导联心电图（ECG）以诊断 ST 段抬高型心肌梗死（STEMI）。在 ROSC 的早期后阶段，ECG 可能显示出并非源于冠状动脉的缺血迹象，而 ROSC 后的低灌注可能会影响 ECG 的可靠性。我们寻求了 ROSC 后外周灌注指数（PI）值与 STEMI 心电图假阳性率之间的关联。
我们考虑了 2015 年 1 月 1 日至 2020 年 12 月 31 日期间在意大利帕维亚的圣马泰奥基金会 IRCCS 教学医院（Fondazione IRCCS Policlinico San Matteo）连续收治的所有 ROSC 后持续性心搏骤停（OHCA）患者。如果 ECG 符合 STEMI 标准但没有值得治疗的关键阻塞性冠状动脉疾病，则将其定义为假阳性。计算了 30 分钟监测（MPI30）期间 PI 的平均值。
在 351 例 ROSC 后可进行 ECG 的患者中，有 84 例患者进行了 PI 监测和有创冠状动脉造影（ICA）。假阳性率为 16/54（29.6%），在三个 MPI 三分位数组中差异有统计学意义[T1（0.2-1）：28.6%；T2（1.1-2.5）：24.1%；T3（2.6-6.9）：3.7%，p=0.04；趋势检验 p=0.02]。心脏骤停持续时间[比值比（OR）1.06（95%CI 1-1.1），p=0.007]和 MPI[T3 与 T1：OR 0.09（95%CI 0.01-0.8），p=0.03]与获得假阳性 ECG 的概率显著相关。当 MPI 调整为心脏骤停持续时间时，这种关联仍然成立[OR 0.2（95%CI 0.1-0.6），p<0.001]。
ROSC 后 STEMI 心电图的假阳性率与灌注不足有关。我们的结果可以帮助识别适合立即进行 ICA 的合适人选。
