1. Pre-hospital body surface potential mapping improves early diagnosis of acute coronary artery occlusion in patients with ventricular fibrillation and cardiac arrest
- Author
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A.A.J. Adgey, Peter J Scott, Michael J Daly, Mark Harbinson, Chris D. Nugent, and Dewar D. Finlay
- Subjects
Male ,Emergency Medical Services ,medicine.medical_specialty ,Resuscitation ,Emergency Nursing ,Coronary Angiography ,Sensitivity and Specificity ,Electrocardiography ,Risk Factors ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Body Surface Potential Mapping ,medicine.disease ,Early Diagnosis ,medicine.anatomical_structure ,Coronary Occlusion ,Coronary occlusion ,Area Under Curve ,Ventricular Fibrillation ,Emergency ,Angiography ,Ventricular fibrillation ,Emergency Medicine ,Cardiology ,Coronary care unit ,Female ,Cardiology and Cardiovascular Medicine ,business ,Out-of-Hospital Cardiac Arrest ,TIMI ,Artery - Abstract
Aims: To determine whether 80-lead body surface potential mapping (BSPM) improves detection of acute coronary artery occlusion in patients presenting with out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) and who survived to reach hospital. Methods and results: Of 645 consecutive patients with OHCA who were attended by the mobile coronary care unit, VF was the initial rhythm in 168 patients. Eighty patients survived initial resuscitation, 59 of these having had BSPM and 12-lead ECG post-return of spontaneous circulation (ROSC) and in 35 patients (age 69±13 yrs; 60% male) coronary angiography performed within 24. h post-ROSC. Of these, 26 (74%) patients had an acutely occluded coronary artery (TIMI flow grade [TFG] 0/1) at angiography. Twelve-lead ECG criteria showed ST-segment elevation (STE) myocardial infarction (STEMI) using Minnesota 9-2 criteria - sensitivity 19%, specificity 100%; ST-segment depression (STD) =0.05. mV in =2 contiguous leads - sensitivity 23%, specificity 89%; and, combination of STEMI or STD criteria - sensitivity 46%, specificity 100%. BSPM STE occurred in 23 (66%) patients. For the diagnosis of TFG 0/1 in a main coronary artery, BSPM STE had sensitivity 88% and specificity 100% (c-statistic 0.94), with STE occurring most commonly in either the posterior, right ventricular or high right anterior territories. Conclusion: Among OHCA patients presenting with VF and who survived resuscitation to reach hospital, post-resuscitation BSPM STE identifies acute coronary occlusion with sensitivity 88% and specificity 100% (c-statistic 0.94). © 2012 Elsevier Ireland Ltd.
- Published
- 2013