Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), Lévis, QC, Canada.
Centre de Recherche du CISSS Chaudières-Appalaches, Lévis, QC, Canada.
CJEM. 2023 Sep;25(9):728-735. doi: 10.1007/s43678-023-00565-4. Epub 2023 Aug 12.
Our objective was to determine characteristics of electrocardiograms (ECG) that predict ventricular fibrillation (VF) among prehospital patients with suspected ST-segment elevation myocardial infarction (STEMI) in Québec.
We performed a matched case-control study of prehospital adult suspected with STEMI. Patients in case group (STEMI/VF+) were matched with controls (STEMI/VF-) for age and sex and then compared for ECG characteristics, including ST-segment elevations (STE) and depressions (STD), duration of interval complexes, general characteristics, and several calculated variables. Logistic regression was used to measure the association between ECG characteristics and VF development.
Overall, 310 prehospital patients with suspected STEMI were included in the analysis (case group, n = 155; control group, n = 155). We confirmed that the presence of TW-pattern complex (OR 7.0, 95% CI 1.55-31.58), premature ventricular contraction (PVC) (OR 5.5, 95% CI 2.04-14.82), and STE in V2-V6 (OR 3.8, 95% CI 1.21-11.74) were electrocardiographic predictors of VF. We also observed that STD in V3-V5 (OR 6.5, 95% CI 1.42-29.39), atrial fibrillation (AF) ≥ 100 beats per minute (bpm) (OR 6.3, 95% CI 1.80-21.90), the combination of STE in V4 and V5, and STD in II, III and aVF (OR 4.8, 95% CI 1.01-22.35), and the presence of STD in ≥ 6 leads (OR 4.2, 95% CI 1.33-13.13) were also associated with VF development. Finally, simultaneous association of 2 (OR 2.3, 95% CI 1.13-4.06) and 3 (OR 11.6, 95% CI 3.22-41.66) predictors showed significant association with VF.
In addition to some already known predictors, we have identified several ECG findings associated with the development of VF in patients with suspected STEMI. Early identification of patients with STEMI at increased risk of VF should help EMS providers anticipate adverse events and encourage use of defibrillation pads.
我们旨在确定心电图（ECG）的特征，这些特征可预测魁北克省院前怀疑 ST 段抬高型心肌梗死（STEMI）患者发生心室颤动（VF）的可能性。
我们对院前成年疑似 STEMI 患者进行了病例对照研究。病例组（STEMI/VF+）患者按年龄和性别与对照组（STEMI/VF-）进行匹配，然后比较 ECG 特征，包括 ST 段抬高（STE）和压低（STD）、间隔复合体的持续时间、一般特征和几个计算变量。使用逻辑回归测量 ECG 特征与 VF 发展之间的关联。
总体而言，分析中包括 310 例院前怀疑 STEMI 患者（病例组，n=155；对照组，n=155）。我们证实 TW 模式复合体（OR 7.0，95%CI 1.55-31.58）、室性早搏（PVC）（OR 5.5，95%CI 2.04-14.82）和 V2-V6 的 STE（OR 3.8，95%CI 1.21-11.74）是 VF 的心电图预测因子。我们还观察到 V3-V5 的 STD（OR 6.5，95%CI 1.42-29.39）、房颤（AF）≥100 次/分钟（bpm）（OR 6.3，95%CI 1.80-21.90）、V4 和 V5 的 STE 与 II、III 和 aVF 的 STD 相结合（OR 4.8，95%CI 1.01-22.35）以及≥6 个导联的 STD（OR 4.2，95%CI 1.33-13.13）也与 VF 的发展相关。最后，同时存在 2 个（OR 2.3，95%CI 1.13-4.06）和 3 个（OR 11.6，95%CI 3.22-41.66）预测因子与 VF 显著相关。
除了一些已知的预测因子外，我们还发现了一些与怀疑 STEMI 患者 VF 发展相关的 ECG 表现。早期识别 STEMI 患者发生 VF 的风险增加有助于 EMS 提供者预测不良事件并鼓励使用除颤垫。
