Journal
RESUSCITATION
Volume 120, Issue -, Pages 125-131Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.resuscitation.2017.08.219
Keywords
Cardiopulmonary resuscitation; Heart arrest; Sudden cardiac death; Arrhythmia; ST-segment elevation myocardial infarction; Quantitative waveform measures; Ventricular fibrillation
Categories
Funding
- Netherlands Heart Foundation [2013T034]
- NHLBI [1R01HL117979-01A1, 5K12HL109068-04]
- Laerdal Foundation Grant
- Netherlands CardioVascular Research Initiative
- Dutch Heart Foundation
- Dutch Federation of University Medical Centres
- Netherlands Organisation for Health Research and Development
- Royal Netherlands Academy of Sciences (PREDICT project)
- Netherlands Organization for Scientific Research (NWO) [ZonMW Vici 918.86.616]
- Dutch Medicines Evaluation Board (MEB/CBG)
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Background: Amplitude spectrum area (AMSA) of ventricular fibrillation (VF) has been associated with survival from out-of-hospital cardiac arrest (OHCA). Ischemic heart disease has been shown to change AMSA. We studied whether the association between AMSA and survival changes with acute ST-elevation myocardial infarction (STEMI) as cause of the OHCA and/or previous MI. Methods: Multivariate logistic regression with log-transformed AMSA of first artifact-free VF segment was used to assess the association between AMSA and survival, according to presence of STEMI or previous MI, adjusting for resuscitation characteristics, medication use and comorbidities. Results: Of 716 VF-patients included from an OHCA-registry in the Netherlands, 328 (46%) had STEMI as cause of OHCA. Previous MI was present in 186 (26%) patients. Survival was 66%; neither previous MI (P = 0.11) nor STEMI (P = 0.78) altered survival. AMSA was a predictor of survival (ORadj: 1.52, 95%-CI: 1.28-1.82). STEMI was associated with lower AMSA (8.4 mV-Hz [3.7-16.5] vs. 12.3 mV-Hz [5.6-23.0]; P < 0.001), but previous MI was not (9.5 mV-Hz [3.9-18.0] vs 10.6 mV-Hz [4.6-19.3]; P = 0.27). When predicting survival, there was no interaction between previous MI and AMSA (P = 0.14). STEMI and AMSA had a significant interaction (P = 0.002), whereby AMSA was no longer a predictor of survival (ORadj: 1.03, 95%-CI: 0.77-1.37) in STEMI-patients. In patients without STEMI, higher AMSA was associated with higher survival rates (ORadj: 1.80, 95%-CI: 1.39-2.35). Conclusions: The prognostic value of AMSA is altered by the presence of STEMI: while AMSA has strong predictive value in patients without STEMI, AMSA is not a predictor of survival in STEMI-patients. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.
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