Is two-dimensional echocardiography better than electrocardiography for predicting patient outcomes after cardiac arrest?
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Background: Coronary artery stenosis increases hospital mortality and leads to poor neurologicalrecovery in cardiac arrest (CA) patients. However, electrocardiography (ECG) cannotfully predict the presence of coronary artery stenosis in CA patients. Hence, we aimed to determinewhether regional wall motion abnormality (RWMA), as observed by two-dimensionalechocardiography (2DE), predicted patient survival outcomes with greater accuracy than didST segment elevation (STE) on ECG in CA patients who underwent coronary angiography(CAG) after return of spontaneous circulation. Methods: This was a retrospective observational study of adult patients with CA of presumedcardiac etiology who underwent CAG at a single tertiary care hospital. We investigatedwhether RWMA observed on 2DE predicted patient outcomes more accurately than did STEobserved on ECG. The primary outcome was incidence of hospital mortality. The secondaryoutcomes were Glasgow-Pittsburgh Cerebral Performance Category scores measured 6months after discharge and significant coronary artery stenosis on CAG. Results: Among the 145 patients, 36 (24.8%) experienced in-hospital death. In multivariableanalysis of survival outcomes, only total arrest time (P=0.011) and STE (P=0.035) were significant. The odds ratio (OR) and 95% confidence interval (CI), which were obtained by adjustingthe total arrest time for survival outcomes, were significant only for STE (OR, 0.40;95% CI, 0.17–0.94). The presence of RWMA was not a significant factor. Conclusions: While STE predicted survival outcomes in adult CA patients, RWMA did not. Thedecision to perform CAG after CA should include ECG under existing guidelines. The use ofRWMA has limited benefits in treatment of this population.
Abstract
Background: Coronary artery stenosis increases hospital mortality and leads to poor neurologicalrecovery in cardiac arrest (CA) patients. However, electrocardiography (ECG) cannotfully predict the presence of coronary artery stenosis in CA patients. Hence, we aimed to determinewhether regional wall motion abnormality (RWMA), as observed by two-dimensionalechocardiography (2DE), predicted patient survival outcomes with greater accuracy than didST segment elevation (STE) on ECG in CA patients who underwent coronary angiography(CAG) after return of spontaneous circulation. Methods: This was a retrospective observational study of adult patients with CA of presumedcardiac etiology who underwent CAG at a single tertiary care hospital. We investigatedwhether RWMA observed on 2DE predicted patient outcomes more accurately than did STEobserved on ECG. The primary outcome was incidence of hospital mortality. The secondaryoutcomes were Glasgow-Pittsburgh Cerebral Performance Category scores measured 6months after discharge and significant coronary artery stenosis on CAG. Results: Among the 145 patients, 36 (24.8%) experienced in-hospital death. In multivariableanalysis of survival outcomes, only total arrest time (P=0.011) and STE (P=0.035) were significant. The odds ratio (OR) and 95% confidence interval (CI), which were obtained by adjustingthe total arrest time for survival outcomes, were significant only for STE (OR, 0.40;95% CI, 0.17–0.94). The presence of RWMA was not a significant factor. Conclusions: While STE predicted survival outcomes in adult CA patients, RWMA did not. Thedecision to perform CAG after CA should include ECG under existing guidelines. The use ofRWMA has limited benefits in treatment of this population.
참고문헌 (32)
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