Associations between common ECG abnormalities and out-of-hospital cardiac arrest

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  • Marc Meller Søndergaard
  • Jonas Bille Nielsen
  • Rikke Nørmark Mortensen
  • Gislason, Gunnar Hilmar
  • Køber, Lars Valeur
  • Freddy Lippert
  • Claus Graff
  • Stig Haunsø
  • Svendsen, Jesper Hastrup
  • Kristian Hay Kragholm
  • Adrian Holger Pietersen
  • Bent Struer Lind
  • Søren Pihlkjær Hjortshøj
  • Anders Gaarsdal Holst
  • Johannes Jan Struijk
  • Christian Torp-Pedersen
  • Steen Møller Hansen

Background: Out-of-hospital cardiac arrest (OHCA) is often the first manifestation of unrecognised cardiac disease. ECG abnormalities encountered in primary care settings may be warning signs of OHCA.

Objective: We examined the association between common ECG abnormalities and OHCA in a primary care setting.

Methods: We cross-linked individuals who had an ECG recording between 2001 and 2011 in a primary care setting with the Danish Cardiac Arrest Registry and identified OHCAs of presumed cardiac cause.

Results: A total of 326 227 individuals were included and 2667 (0,8%) suffered an OHCA. In Cox regression analyses, adjusted for age and sex, the following ECG findings were strongly associated with OHCA: ST-depression without concomitant atrial fibrillation (HR 2.79; 95% CI 2.45 to 3.18), left bundle branch block (LBBB; HR 3.44; 95% CI 2.85 to 4.14) and non-specific intraventricular block (NSIB; HR 3.15; 95% CI 2.58 to 3.83). Also associated with OHCA were atrial fibrillation (HR 1.89; 95% CI 1.63 to 2.18), Q-wave (HR 1.75; 95% CI 1.57 to 1.95), Cornell and Sokolow-Lyon criteria for left ventricular hypertrophy (HR 1.56; 95% CI 1.33 to 1.82 and HR 1.27; 95% CI 1.12 to 1.45, respectively), ST-elevation (HR 1.40; 95% CI 1.09 to 1.54) and right bundle branch block (HR 1.29; 95% CI 1.09 to 1.54). The association between ST-depression and OHCA diminished with concomitant atrial fibrillation (HR 1.79; 95% CI 1.42 to 2.24, p < 0.01 for interaction). Among patients suffering from OHCA, without a known cardiac disease at the time of the cardiac arrest, 14.2 % had LBBB, NSIB or ST-depression.

Conclusions: Several common ECG findings obtained from a primary care setting are associated with OHCA.

OriginalsprogEngelsk
Artikelnummere000905
TidsskriftOpen Heart
Vol/bind6
Udgave nummer1
Antal sider9
ISSN2398-595X
DOI
StatusUdgivet - 2019

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