Silwanis Claudio, Maier Julian, Eder Johannes, Groche Max, Nahler Alexander, Fellner Alexander, Blessberger Hermann, Kellermair Jörg, Steinwender Clemens, Lambert Thomas
Kepler University Hospital Linz, Department of Cardiology and Medical Intensive Care, Medical Faculty, Johannes Kepler University, Linz, Austria.
Kepler University Hospital Linz, Department of Cardiology and Medical Intensive Care, Medical Faculty, Johannes Kepler University, Linz, Austria; Clinical Research Institute for Cardiovascular and Metabolic Diseases, Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.
Resuscitation. 2025 Oct;215:110763. doi: 10.1016/j.resuscitation.2025.110763. Epub 2025 Aug 7.
BACKGROUND/AIM: Immediate coronary angiography (CAG) is recommended for patients with ST-elevation myocardial infarction (STEMI) after out-of-hospital cardiac arrest (OHCA). However, some occlusive myocardial infarctions (OMI) do not meet STEMI criteria. This study investigated whether additional ECG patterns beyond STEMI could more accurately identify OMI in OHCA patients, compared to using STEMI criteria alone.
This retrospective study categorised patients based on their first post-resuscitation ECG into two groups: STEMI and non-STEMI with high-risk ECG criteria and compared them for OMI by CAG.
Among 97 patients OMI was identified in 55 % (53/97) of patients, specifically in 25 of 31 with STEMI (81 %), 24 of 29 with high-risk ECG (83 %), and 4 of 37 patients with neither (11 %). Combining STEMI and high-risk ECG criteria would have predicted OMI in 92 % (49/53) of cases. Patients with high-risk ECG experienced significantly longer median delays until CAG (101.5 [IQR 63-336.75] vs. 47.5 [25.75-71.25] minutes; p = 0.004) compared to those with STEMI on the ECG. Although 30-day mortality did not differ between STEMI and high-risk ECG patients (p = 0.973), survival-differences could be observed between groups. Syntax-I-Score was significantly higher in the high-risk ECG group (29 [IQR 19-38] vs. 15 [IQR 3-24.5]; p = 0.002).
Combining STEMI and high-risk ECG criteria improves OMI prediction compared to STEMI criteria alone, potentially enabling faster treatment and better OHCA survival.
背景/目的：对于院外心脏骤停（OHCA）后发生ST段抬高型心肌梗死（STEMI）的患者，建议立即进行冠状动脉造影（CAG）。然而，一些闭塞性心肌梗死（OMI）并不符合STEMI标准。本研究调查了与仅使用STEMI标准相比，超出STEMI的额外心电图模式是否能更准确地识别OHCA患者中的OMI。
这项回顾性研究根据患者复苏后的首次心电图将患者分为两组：STEMI组和具有高危心电图标准的非STEMI组，并通过CAG比较两组的OMI情况。
在97例患者中，55%（53/97）的患者被诊断为OMI，具体而言，31例STEMI患者中有25例（81%），29例高危心电图患者中有24例（83%），37例两者均无的患者中有4例（11%）。将STEMI和高危心电图标准结合起来可以预测92%（49/53）的OMI病例。与心电图表现为STEMI的患者相比，高危心电图患者进行CAG的中位延迟时间显著更长（101.5[四分位间距63 - 336.75]分钟 vs. 47.5[25.75 - 71.25]分钟；p = 0.004）。尽管STEMI患者和高危心电图患者的30天死亡率没有差异（p = 0.973），但两组之间可以观察到生存差异。高危心电图组的Syntax - I - Score显著更高（29[四分位间距19 - 38] vs. 15[四分位间距3 - 24.5]；p = 0.002）。
与单独使用STEMI标准相比，结合STEMI和高危心电图标准可改善OMI预测，有可能实现更快的治疗并提高OHCA患者的生存率。
