Resuscitation · 2026
The Post-ROSC ECG: Morphological Spectrum of Non-ST-Elevation Occlusion and Prognostic Markers After Cardiac Arrest.
СтатьяНазвание и аннотация: Перевод в очереди
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Silwanis Claudio, Groche Max, Huss Maximilian, Pichler Philipp, Bamberger Melanie, Maier Cheyenne, Yorulmaz Levent, Fellner Alexander, Nahler Alexander, Rechberger Stefan, Blessberger Hermann, Purkarthofer David, Kellermair Jörg, Maier Julian, Steinwender Clemens, Lambert Thomas
Аннотация
BACKGROUND: Occlusive myocardial infarction (OMI) frequently presents without ST-elevation (NST-OMI) after return of spontaneous circulation (ROSC), complicating triage decisions. Aim of this study was to (i) characterise the distribution of NST-OMI patterns post-ROSC and (ii) determine whether quantitative ECG features are associated with survival.
METHODS: In this retrospective single-centre analysis, the first post-ROSC ECG of cardiac arrest survivors admitted to a tertiary ICU (2020-2025) was evaluated for STEMI and NST-OMI patterns and for quantitative intervals (PQ, PR, P-wave, QRS, QTc). Coronary angiography (CAG) served as the reference standard for OMI.
RESULTS: Of 214 patients, 101 had CAG-confirmed OMI, wherein left-main equivalent and Smith-modified Sgarbossa criteria were the most prevalent NST-OMI patterns (each 8%), followed by Aslanger pattern (5%), lateral OMI, shark-fin sign and hyperacute t-wave (each 4%). NST-OMI patterns were more prevalent both overall (35% vs. 24%) and among CAG-confirmed OMI cases (48% vs. 44%) yet underwent CAG less frequently (78% vs. 98%; p=0.002), with the highest 30-day mortality among NST-OMI patients not undergoing CAG (75%; p=0.005). Regarding ECG features, non-survivors had longer PR-segment (74 vs. 57ms; p=0.008) and QRS-duration (130 vs. 108ms; p=0.003), and shorter P-wave duration (105 vs. 108ms; p=0.027). After multivariable adjustment, PR-segment prolongation was independently associated with reduced 30-day survival (aOR 0.977 [0.956-0.998]; p=0.032).
CONCLUSIONS: On the first post-ROSC ECG, angiographically confirmed occlusion concentrated around a small number of NST-OMI morphologies - findings of crucial importance for identification and appropriate management. PR-segment prolongation predicted reduced 30-day survival - indicating prognostic information beyond ischaemia detection.
METHODS: In this retrospective single-centre analysis, the first post-ROSC ECG of cardiac arrest survivors admitted to a tertiary ICU (2020-2025) was evaluated for STEMI and NST-OMI patterns and for quantitative intervals (PQ, PR, P-wave, QRS, QTc). Coronary angiography (CAG) served as the reference standard for OMI.
RESULTS: Of 214 patients, 101 had CAG-confirmed OMI, wherein left-main equivalent and Smith-modified Sgarbossa criteria were the most prevalent NST-OMI patterns (each 8%), followed by Aslanger pattern (5%), lateral OMI, shark-fin sign and hyperacute t-wave (each 4%). NST-OMI patterns were more prevalent both overall (35% vs. 24%) and among CAG-confirmed OMI cases (48% vs. 44%) yet underwent CAG less frequently (78% vs. 98%; p=0.002), with the highest 30-day mortality among NST-OMI patients not undergoing CAG (75%; p=0.005). Regarding ECG features, non-survivors had longer PR-segment (74 vs. 57ms; p=0.008) and QRS-duration (130 vs. 108ms; p=0.003), and shorter P-wave duration (105 vs. 108ms; p=0.027). After multivariable adjustment, PR-segment prolongation was independently associated with reduced 30-day survival (aOR 0.977 [0.956-0.998]; p=0.032).
CONCLUSIONS: On the first post-ROSC ECG, angiographically confirmed occlusion concentrated around a small number of NST-OMI morphologies - findings of crucial importance for identification and appropriate management. PR-segment prolongation predicted reduced 30-day survival - indicating prognostic information beyond ischaemia detection.