Is a STEMI a STEMI in Post-ROSC Patients?
/McFadden, P., Reynolds, J. C., Madder, R. D. & Brown, M. Diagnostic test accuracy of the initial electrocardiogram after resuscitation from cardiac arrest to indicate invasive coronary angiographic findings and attempted revascularization: A systematic review and meta-analysis. Resuscitation 160, 20–36 (2021).
In this systematic review and meta-analysis of the diagnostic test accuracy of the post-ROSC EKG to predict acute coronary lesion or revascularization on coronary angiography in adults after cardiac arrest, ST elevation was found to more specific than sensitive test characteristics and all groups and subgroups. The authors found a sensitivity of ST elevation on the post-ROSC EKG for discovery of an acute coronary lesion during coronary angiography of 0.70, with a specificity of 0.85. When evaluating the test characteristics of ST elevation on the post-ROSC EKG for revascularization during coronary angiography, they found a sensitivity of 0.53 to and a specificity of 0.86. Confidence intervals for these test characteristics were reasonable.
While the study is limited by heterogeneity in reporting on previous cohorts and a relatively small number of studies without significant bias in selection for CAG, the study’s methodology is complex but well described and follows established guidelines for this type of paper.
The findings of relatively high, but still imperfect, specificity and a lower sensitivity in all groups and sub-groups should caution clinicians in Emergency Department and ICU settings against reliance on the post-ROSC EKG as a stand-alone test to determine need or potential benefit from coronary angiography. Ideal selection and timing of patients for coronary angiography following cardiac arrest remains an area of controversy and active research.
Check some of our other posts on EKG Interpretation and Post-ROSC STEMI!
Authorship
Written by Brandon Berger, MD, PGY-3 University of Cincinnati Department of Emergency Medicine
Peer Review and Editing by Jeffery Hill, MD MEd
