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Clinical Pearl

Correctly Identify STEMI Following ROSC

doi: 10.1097/01.EEM.0000758836.80385.52


    An ECG should be obtained after achieving return of spontaneous circulation following out-of-hospital cardiac arrest to identify the need for an urgent coronary angiography, which is typically indicated only in the case of a STEMI. (JAMA Netw Open. 2021;4[1]:e2032875;; Eur Heart J. 2018;39(2):119;; Circulation. 2015;132[18 Suppl 2]:S465;

    If the ECG is obtained too early in the post-ROSC phase, the ECG findings could reflect ischemia due to the lack of or low blood flow during cardiac arrest more than or in addition to ischemia from coronary artery pathology, possibly leading to overdiagnosis of STEMI. (JAMA Netw Open. 2021;4[1]:e2032875;

    A recent retrospective multicenter study of 370 consecutive adult patients resuscitated from OHCA found that early ECG acquisition after ROSC is associated with a higher percentage of false-positive ECG findings for STEMI. (JAMA Netw Open. 2021;4[1]:e2032875; Those false-positives were three times greater when the ECG was acquired in the first seven minutes after ROSC rather than after eight.

    This study suggests that it may be reasonable to wait at least eight minutes after ROSC for ECG acquisition or repeating the ECG after a few minutes in the case of an early ECG that is diagnostic of STEMI to correctly identify patients who may benefit from an immediate coronary angiography.

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