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Gentile FR, Baldi E, Klersy C, Schnaubelt S, Caputo ML, Clodi C, Bruno J, Compagnoni S, Fasolino A, Benvenuti C, Domanovits H, Burkart R, Primi R, Ruzicka G, Holzer M, Auricchio A, Savastano S. Association Between Postresuscitation 12-Lead ECG Features and Early Mortality After Out-of-Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study. J Am Heart Assoc 2023; 12:e027923. [PMID: 37183852 DOI: 10.1161/jaha.122.027923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background Once the return of spontaneous circulation after out-of-hospital cardiac arrest is achieved, a 12-lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30-day survival in patients with out-of-hospital cardiac arrest. Methods and Results All the post-return of spontaneous circulation ECGs from January 2015 to December 2018 in 3 European centers (Pavia, Lugano, and Vienna) were collected. Prehospital data were collected according to the Utstein style. A total of 370 ECGs were collected: 287 men (77.6%) with a median age of 62 years (interquartile range, 53-70 years). After correction for the return of spontaneous circulation-to-ECG time, age >62 years (hazard ratio [HR], 1.78 [95% CI, 1.21-2.61]; P=0.003), female sex (HR, 1.5 [95% CI, 1.05-2.13]; P=0.025), QRS wider than 120 ms (HR, 1.64 [95% CI, 1.43-1.87]; P<0.001), the presence of a Brugada pattern (HR, 1.49 [95% CI, 1.39-1.59]; P<0.001), and the presence of ST-segment elevation in >1 segment (HR, 1.75 [95% CI, 1.59-1.93]; P<0.001) were independently associated with 30-day mortality. A score ranging from 0 to 26 was created, and by dividing the population into 3 tertiles, 3 classes of risk were found with significantly different survival rate at 30 days (score 0-4, 73%; score 5-7, 66%; score 8-26, 45%). Conclusions The post-return of spontaneous circulation ECG can identify patients who are at high risk of mortality after out-of-hospital cardiac arrest earlier than other forms of prognostication. This provides important risk stratification possibilities in postcardiac arrest care that could help to direct treatments and improve outcomes in patients with out-of-hospital cardiac arrest.
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Affiliation(s)
- Francesca Romana Gentile
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | | | - Christian Clodi
- Department of Emergency Medicine Medical University of Vienna Wien Austria
| | | | - Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Alessandro Fasolino
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | - Hans Domanovits
- Clinical Epidemiology and Biometry Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | - Roberto Primi
- Division of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Gerhard Ruzicka
- Department of Emergency Medicine Medical University of Vienna Wien Austria
| | - Michael Holzer
- Department of Emergency Medicine Medical University of Vienna Wien Austria
| | | | - Simone Savastano
- Division of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
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Niederdöckl J, Oppenauer J, Schnaubelt S, Cacioppo F, Buchtele N, Warenits AM, Laggner R, Schütz N, Bögl MS, Ruzicka G, Gupta S, Lutnik M, Sheikh Rezaei S, Wolzt M, Herkner H, Domanovits H, Laggner AN, Schwameis M, Hijazi Z. The ABC-Stroke Score Refines Stroke Risk Stratification in Patients With Atrial Fibrillation at the Emergency Department. Front Med (Lausanne) 2022; 9:830580. [PMID: 35833107 PMCID: PMC9271836 DOI: 10.3389/fmed.2022.830580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
AimsTo evaluate the performance of the ABC (Age, Biomarkers, Clinical history) and CHA2DS2-VASc stroke scores under real-world conditions in an emergency setting.Methods and ResultsThe performance of the biomarker-based ABC-stroke score and the clinical variable-based CHA2DS2-VASc score for stroke risk assessment were prospectively evaluated in a consecutive series of 2,108 patients with acute symptomatic atrial fibrillation at a tertiary care emergency department. Performance was assessed according to methods for the development and validation of clinical prediction models by Steyerberg et al. and the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis. During a cumulative observation period of 3,686 person-years, the stroke incidence rate was 1.66 per 100 person-years. Overall, the ABC-stroke and CHA2DS2-VASc scores revealed respective c-indices of 0.64 and 0.55 for stroke prediction. Risk-class hazard ratios comparing moderate to low and high to low were 3.51 and 2.56 for the ABC-stroke score and 1.10 and 1.62 for the CHA2DS2-VASc score. The ABC-stroke score also provided improved risk stratification in patients with moderate stroke risk according to the CHA2DS2-VASc score, who lack clear recommendations regarding anticoagulation therapy (HR: 4.35, P = 0.001). Decision curve analysis indicated a superior net clinical benefit of using the ABC-stroke score.ConclusionIn a large, real-world cohort of patients with acute atrial fibrillation in the emergency department, the ABC-stroke score was superior to the guideline-recommended CHA2DS2-VASc score at predicting stroke risk and refined risk stratification of patients labeled moderate risk by the CHA2DS2-VASc score, potentially easing treatment decision-making.
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Affiliation(s)
- Jan Niederdöckl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Oppenauer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Filippo Cacioppo
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Roberta Laggner
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Nikola Schütz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Magdalena S. Bögl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerhard Ruzicka
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sophie Gupta
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Lutnik
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Anton N. Laggner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
- *Correspondence: Michael Schwameis
| | - Ziad Hijazi
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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3
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Gentile F, Baldi E, Schnaubelt S, Caputo M, Clodi C, Bruno J, Compagnoni S, Benvenuti C, Domanovits H, Burkart R, Primi R, Ruzicka G, Holzer M, Auricchio A, Savastano S. C60 12–LEAD POST–ROSC ELECTROCARDIOGRAM DISCRIMINATES SURVIVAL TO HOSPITAL DISCHARGE. A SUB–ANALYSIS OF THE PEACE STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Once the return of spontaneous circulation (ROSC) after an out–of–hospital cardiac arrest (OHCA) is achieved in patients with an ST–elevation myocardial infarction, the acquisition of a 12–lead electrocardiogram (ECG) is strongly recommended in order to determine candidates for urgent coronary angiography. However, little is known so far about the association of ECG features and survival to hospital discharge in OHCA patients.
Methods
We analysed all the post–ROSC ECGs collected from January 2015 to December 2018 in three European centres (Pavia, Lugano and Vienna). For every ECG, the main features were analysed and filed in the database together with the pre–hospital data collected for every patient according to the Utstein style.
Results
We collected 370 ECGs: 287 males (77.6%); median age 62 years old (IQR 53–70 years); 121 from Pavia (32.7%), 38 from Lugano (10.3%) and 211 from Vienna (57.0%). In Cox univariable regression, age older than 62 years [HR 1.7 (95% IC 1.1–2.4), p = 0.007], QRS wider than 120 msec [HR 1.87 (95% IC 1.3–2.7), p < 0.001], ST elevation in more than one segment [HR 1.7(95% IC 1.2–2.5),p=0.003], the presence of left bundle branch block (LBBB) [HR 1.7 (95% IC 1.1–2.9), p = 0.03] and a right bundle branch block [HR 1.8 (95% IC 1.1–2.8), p = 0.01] were all associated with death before hospital discharge. In multivariable Cox regression, adjusted for the ROSC–to–ECG time, age older than 62 years [HR 1.6 (95% IC 1.1–2.3), p = 0.01], QRS wider than 120 msec [HR 1.7 (95%IC 1.2–2.5), p = 0.004] and the presence of ST elevation in more than one segment [HR 1.7 (95%IC 1.2–2.5), p = 0.004] were independently associated with death before hospital discharge. By considering these latter three risk factors, the rate of survival to hospital discharge was significantly influenced by their number [no risk factor: 80.8%; 1 factor: 71.2%; 2 factors: 61.9%; 3 factors: 34.4%; p < 0.001, p for trend <0.001]. With a Cox regression model, considering the absence of risk factor as a reference, we confirmed that having 2 or 3 risk factors was significantly associated with death before hospital discharge [HR 1.9 (95%IC 1–3.5), p = 0.037 e HR 5.1(95%IC 2.6–10.1), p < 0.001 respectively].
Conclusions
Our study confirms the central role of ECG in STEMI patients resuscitated after an OHCA and proves that post–ROSC ECG features can be used for both the selection of patients who may benefit from urgent coronary angiography as well as for prognostic stratifications.
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Affiliation(s)
- F Gentile
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - E Baldi
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - S Schnaubelt
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - M Caputo
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - C Clodi
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - J Bruno
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - S Compagnoni
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - C Benvenuti
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - H Domanovits
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - R Burkart
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - R Primi
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - G Ruzicka
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - M Holzer
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - A Auricchio
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - S Savastano
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
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4
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Mangold A, Ondracek AS, Hofbauer TM, Scherz T, Artner T, Panagiotides N, Beitzke D, Ruzicka G, Nistler S, Wohlschläger-Krenn E, Winker R, Quehenberger P, Traxler-Weidenauer D, Spannbauer A, Gyöngyösi M, Testori C, Lang IM. Culprit site extracellular DNA and microvascular obstruction in ST-elevation myocardial infarction. Cardiovasc Res 2021; 118:2006-2017. [PMID: 34173822 DOI: 10.1093/cvr/cvab217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/23/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS Extracellular chromatin and deoxyribonuclease (DNase) have been identified as important players of thrombosis, inflammation and homeostasis in a murine model. We previously demonstrated that activated neutrophils release neutrophil extracellular traps (NETs) at the culprit site in ST elevation myocardial infarction (STEMI), which significantly contribute to extracellular chromatin burden, and are associated with larger infarcts. To understand the correlation between neutrophil activation, extracellular chromatin and infarct size (IS), we investigated these parameters in a porcine myocardial infarction model, and at different time points and sites in a prospective STEMI trial with cardiac magnetic resonance (CMR) endpoints. METHODS AND RESULTS In a prospective STEMI trial (NCT01777750), 101 STEMI patients were included and blood samples were obtained from first medical contact until 6 months after primary percutaneous coronary intervention (pPCI) including direct sampling from the culprit site. CMR was performed 4 ± 2 days and 6 months after pPCI. Neutrophil counts, markers of extracellular chromatin and inflammation were measured. Double-stranded DNA (dsDNA), citrullinated histone 3, nucleosomes, myeloperoxidase, neutrophil elastase and interleukin (IL)-6 were significantly increased, while DNase activity was significantly decreased at the culprit site in STEMI patients. High neutrophil counts and dsDNA levels at the culprit site correlated with high microvascular obstruction (MVO) and low ejection fraction (EF). High DNase activity at the culprit site correlated with low MVO and high EF.In correspondence, dsDNA correlated with IS in the porcine myocardial infarction model. In porcine infarcts, neutrophils and extracellular chromatin were detected in congested small arteries corresponding with MVO. Markers of neutrophil activation, extracellular chromatin, DNase activity and CMR measurements correlated with markers of systemic inflammation C-reactive protein and IL-6 in patients. CONCLUSIONS NETs and extracellular chromatin are important determinants of MVO in STEMI. Rapid degradation of extracellular chromatin by DNases appears to be crucial for microvascular patency and outcome. TRANSLATIONAL PERSPECTIVE We show that NETs and extracellular DNA obstruct microvessels in the porcine myocardial infarction model and is connected to increased infarct size. We are able to prove this observation in human STEMI patients. DNase is capable to counteract these effects. Extracellular DNA could be a new treatment target in STEMI.
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Affiliation(s)
- Andreas Mangold
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Anna S Ondracek
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Thomas M Hofbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Thomas Scherz
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.,Department of Dermatology, Landesklinikum Wiener, Neustadt, Austria
| | - Tyler Artner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Noel Panagiotides
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-guided therapy, Medical University of Vienna, Austria
| | - Gerhard Ruzicka
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Sonja Nistler
- Center of Prevention and Health, Sanatorium Hera, Vienna, Austria
| | | | - Robert Winker
- Center of Prevention and Health, Sanatorium Hera, Vienna, Austria
| | - Peter Quehenberger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Andreas Spannbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Mariann Gyöngyösi
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, Austria.,Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener, Neustadt, Austria
| | - Irene M Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
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5
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Baldi E, Schnaubelt S, Caputo ML, Klersy C, Clodi C, Bruno J, Compagnoni S, Benvenuti C, Domanovits H, Burkart R, Fracchia R, Primi R, Ruzicka G, Holzer M, Auricchio A, Savastano S. Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest. JAMA Netw Open 2021; 4:e2032875. [PMID: 33427885 PMCID: PMC7801935 DOI: 10.1001/jamanetworkopen.2020.32875] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Electrocardiography (ECG) is an important tool to triage patients with out-of-hospital cardiac arrest (OHCA) after return of spontaneous circulation (ROSC). An immediate coronary angiography after ROSC is recommended only in patients with an ECG that is diagnostic of ST-segment elevation myocardial infarction (STEMI). To date, the benefit of this approach has not been demonstrated in patients with a post-ROSC ECG that is not diagnostic of STEMI. OBJECTIVE To assess whether the time from ROSC to ECG acquisition is associated with the diagnostic accuracy of ECG for STEMI. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study (the Post-ROSC Electrocardiogram After Cardiac Arrest study) analyzed consecutive patients older than 18 years who were resuscitated from OHCA between January 1, 2015, and December 31, 2018, and were admitted to 1 of the 3 participating centers in Europe (Pavia, Italy; Lugano, Switzerland; and Vienna, Austria). EXPOSURE Only patients who underwent coronary angiography during hospitalization and who acquired a post-ROSC ECG before the angiography were enrolled. Patients with a nonmedical cause of OHCAs were excluded. MAIN OUTCOMES AND MEASURES The primary end point was false-positive ECG findings, defined as the percentage of patients with post-ROSC ECG findings that met STEMI criteria but who did not show obstructive coronary artery disease on angiography that was worthy of percutaneous coronary angioplasty. RESULTS Of 586 consecutive patients who were admitted to the 3 participating centers, 370 were included in the analysis (287 men [77.6%]; median age, 62 years [interquartile range, 53-70 years]); 121 (32.7%) were enrolled in the participating center in Pavia, Italy; 38 (10.3%) in Lugano, Switzerland; and 211 (57.0%) in Vienna, Austria. The percentage of false-positive ECG findings in the first tertile of ROSC to ECG time (≤7 minutes) was significantly higher than that in the second (8-33 minutes) and third (>33 minutes) tertiles: 18.5% in the first tertile vs 7.2% in the second (odds ratio [OR], 0.34; 95% CI, 0.13-0.87; P = .02) and 5.8% in the third (OR, 0.27; 95% CI, 0.15-0.47; P < .001). These differences remained significant when adjusting for sex (≤7 minutes: reference; 8-33 minutes: OR, 0.32; 95% CI, 0.12-0.85; P = .02; >33 minutes: OR, 0.26; 95% CI, 0.14-0.47; P < .001), age (≤7 minutes: reference; 8-33 minutes: OR, 0.34; 95% CI, 0.13-0.89; P = .03; >33 minutes: OR, 0.27; 95% CI, 0.15-0.46; P < .001), number of segments with ST-elevation (≤7 minutes: reference; 8-33 minutes: OR, 0.35; 95% CI, 0.15-0.81; P = .01; >33 minutes: OR, 0.28; 95% CI, 0.15-0.52; P < .001), QRS duration (≤7 minutes: reference; 8-33 minutes: OR, 0.35; 95% CI, 0.14-0.87; P = .02; >33 minutes: OR, 0.27; 95% CI, 0.15-0.48; P < .001), heart rate (≤7 minutes: reference; 8-33 minutes: OR, 0.35; 95% CI, 0.13-0.93; P = .04; >33 minutes: OR, 0.29; 95% CI, 0.15-0.55; P < .001), epinephrine administered (≤7 minutes: reference; 8-33 minutes: OR, 0.35; 95% CI, 0.13-0.98; P = .045; >33 minutes: OR, 0.27; 95% CI, 0.16-0.48; P < .001), shockable initial rhythm (≤7 minutes: reference; 8-33 minutes: OR, 0.35; 95% CI, 0.13-0.96; P = .04; >33 minutes: OR, 0.26; 95% CI, 0.15-0.46; P < .001), and 3 or more shocks administered (≤7 minutes: reference; 8-33 minutes: OR, 0.36; 95% CI, 0.13-1.00; P = .05; >33 minutes: OR, 0.27; 95% CI, 0.16-0.48; P < .001) in bivariable analyses. CONCLUSIONS AND RELEVANCE This study suggests that early ECG acquisition after ROSC in patients with OHCA is associated with a higher percentage of false-positive ECG findings for STEMI. It may be reasonable to delay post-ROSC ECG by at least 8 minutes after ROSC or repeat the acquisition if the first ECG is diagnostic of STEMI and is acquired early after ROSC.
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Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | | | - Maria Luce Caputo
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Catherine Klersy
- Service of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Jolie Bruno
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | | | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Rosa Fracchia
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gerhard Ruzicka
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Schnaubelt S, Wallmueller C, Mayr F, Losert H, Testori C, Ruzicka G, Graf N, Sterz F, Uray T. Comprehensive pre- and in-hospital near-infrared-spectroscopy can predict outcome parameters in patients after out-of-hospital cardiac arrest – A feasibility study. Resuscitation 2017. [DOI: 10.1016/j.resuscitation.2017.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Sulzgruber P, Sterz F, Schober A, Uray T, Van Tulder R, Hubner P, Wallmüller C, El-Tattan D, Graf N, Ruzicka G, Schriefl C, Zajicek A, Buchinger A, Koller L, Laggner AN, Spiel A. Editor’s Choice-Progress in the chain of survival and its impact on outcomes of patients admitted to a specialized high-volume cardiac arrest center during the past two decades. European Heart Journal: Acute Cardiovascular Care 2016; 5:3-12. [DOI: 10.1177/2048872615620904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Andreas Schober
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Thomas Uray
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Diana El-Tattan
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Nikolaus Graf
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Gerhard Ruzicka
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | | | | | - Lorenz Koller
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Anton N Laggner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Alexander Spiel
- Department of Emergency Medicine, Medical University of Vienna, Austria
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