Prevalence and Prognostic Impact of ST Segment Elevation in Lead aVR Among Patients with Cardiac Arrest.

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal: Acute Cardiovascular Care Pub Date : 2025-01-28 DOI:10.1093/ehjacc/zuaf018

Soumya Banna, Christopher Schenck, Noah Kim, Tariq Ali, Emily J Gilmore, David M Greer, Rachel Beekman, P Elliott Miller

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引用次数: 0

Abstract

Background: In acute coronary syndrome, ST-segment elevation in lead aVR (STE-aVR) indicates global myocardial ischemia, often related to multivessel or severe left main disease, and correlates with increased mortality. The prevalence and prognostic significance of STE-aVR in cardiac arrest (CA) patients is unknown.

Methods: We identified patients (≥18 years) with CA between 2011 to 2022 who achieved return of spontaneous circulation (ROSC). The first electrocardiogram (ECG) post-ROSC was assessed for STE-aVR, defined as ≥1 mm ST-segment elevation at the J point, measured by two trained assessors. Multivariable logistic regression was used to analyze the association between STE-aVR and outcomes (in-hospital mortality and poor neurologic outcome), adjusted for patient and arrest characteristics.

Results: Including 443 CA patients, the median (IQR) age was 61 years (50-72 years), with 60.5% (n=268) male, 65.7% (n=291) presenting with out-of-hospital cardiac arrest (OHCA) and 29.8% (n=132) with shockable rhythms. STE-aVR was observed in 18.3% (n=81) of patients. Those with STE-aVR were more likely to present with OHCA and less likely to have a shockable rhythm (both, P<0.05). STE-aVR was associated with higher in-hospital mortality (86.4% vs 65.8%, P<0.001) and poor neurologic outcomes (90.1% vs 72.9%, P=0.001). After multivariable adjustment, STE-aVR remained associated with higher in-hospital mortality (odds ratio [OR] 2.23; 95% confidence interval [CI]: 1.02-4.84, P=0.04), but not a poor neurologic outcome (OR 2.12; 95% CI: 0.90-4.98, P=0.09).

Conclusions: STE-aVR was present in 1 in 5 CA survivors and was independently associated with higher in-hospital mortality.

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背景：在急性冠状动脉综合征中，aVR 导联 ST 段抬高（STE-aVR）表明心肌整体缺血，通常与多血管或严重左主干疾病有关，并与死亡率增加相关。STE-aVR在心脏骤停（CA）患者中的发生率和预后意义尚不清楚：我们确定了 2011 年至 2022 年期间自发循环恢复（ROSC）的 CA 患者（≥18 岁）。ROSC后的首次心电图（ECG）由两名训练有素的评估者进行STE-aVR评估，STE-aVR的定义是J点处ST段抬高≥1毫米。采用多变量逻辑回归分析 STE-aVR 与预后（院内死亡率和不良神经功能预后）之间的关系，并对患者和停搏特征进行调整：在 443 名 CA 患者中，中位（IQR）年龄为 61 岁（50-72 岁），60.5%（n=268）为男性，65.7%（n=291）为院外心脏骤停（OHCA）患者，29.8%（n=132）为可电击心律。18.3%（81 人）的患者出现 STE-aVR。出现 STE-aVR 的患者更有可能出现 OHCA，而出现可电击心律的可能性较低（两者均为 PConclusions：每 5 名 CA 幸存者中就有 1 人存在 STE-aVR，而且 STE-aVR 与较高的院内死亡率密切相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal: Acute Cardiovascular Care Medicine-General Medicine

CiteScore

8.50

自引率

4.90%

发文量

325

期刊介绍： The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.