PMID- 35041876
OWN - NLM
STAT- MEDLINE
DCOM- 20220325
LR  - 20220325
IS  - 1873-1570 (Electronic)
IS  - 0300-9572 (Linking)
VI  - 172
DP  - 2022 Mar
TI  - Interobserver variability among experienced electrocardiogram readers to diagnose 
      acute thrombotic coronary occlusion in patients with out of hospital cardiac 
      arrest: Impact of metabolic milieu and angiographic culprit.
PG  - 24-31
LID - S0300-9572(22)00006-5 [pii]
LID - 10.1016/j.resuscitation.2022.01.005 [doi]
AB  - OBJECTIVES: We sought to evaluate interobserver concordance among experienced 
      electrocardiogram (ECG) readers in predicting acute thrombotic coronary occlusion 
      (ATCO) in the context of abnormal metabolic milieu (AMM) following resuscitated 
      out of hospital cardiac arrest (OHCA). METHODS: OHCA patients with initial 
      shockable rhythm who underwent invasive coronary angiography (ICA) were included. 
      AMM was defined as one of: pH < 7.1, lactate > 2 mmol/L, serum potassium < 2.8 
      or >6.0 mEq/L. The initial ECG following ROSC but prior to ICA was adjudicated by 
      2 experienced readers using classic ST elevation myocardial infarction [STEMI] 
      and expanded criteria and their combination to predict ATCO on ICA. RESULTS: 152 
      consecutive patients (mean age 58 years, 76% male) met inclusion criteria. AMM 
      was present in 77%; and 42% had ATCO on ICA. Sensitivity, specificity, PPV, NPV 
      using classic STEMI criteria were 50%, 98%, 94%, 72% (c-statistic 0.74); whereas 
      for combined (STEMI + expanded) criteria they were 69%, 88%, 81%, 79% 
      respectively (c-statistic 0.79). Inter-observer agreement (kappa) was 0.7 for 
      classic STEMI criteria, and 0.66 for combined criteria. Agreement between readers 
      was consistently higher when ATCO was absent and with NMM (kappa 0.78), but lower 
      in AMM (kappa 0.6). CONCLUSIONS: Despite experienced ECG readers, there was only 
      modest overall concordance in predicting ATCO in the context of resuscitated 
      OHCA. Significant interobserver variations were noted dependent on metabolic 
      milieu and angiographic ATCO. These observations fundamentally question the role 
      of the 12-lead ECG as primary triaging tool for early angiography among patients 
      with OHCA.
CI  - Copyright (c) 2022 Elsevier B.V. All rights reserved.
FAU - Sharma, Amit
AU  - Sharma A
AD  - Regions Hospital, St. Paul, MN, United States.
FAU - Miranda, David F
AU  - Miranda DF
AD  - CentraCare Heart and Vascular Center, St. Cloud, United States.
FAU - Rodin, Holly
AU  - Rodin H
AD  - Analytic Center of Excellence, Hennepin Healthcare System, HCMC, Minneapolis, MN, 
      United States. Electronic address: Holly.Rodin@hcmed.org.
FAU - Bart, Bradley A
AU  - Bart BA
AD  - Division of Cardiology, Department of Medicine, Veterans Affairs Medical Center 
      and University of Minnesota Medical School, Minneapolis, MN, United States. 
      Electronic address: Bradley.Bart@va.gov.
FAU - Smith, Stephen W
AU  - Smith SW
AD  - Emergency Department, Hennepin Healthcare System, HCMC and University of 
      Minnesota Medical School, Minneapolis, MN, United States. Electronic address: 
      smith253@umn.edu.
FAU - Shroff, Gautam R
AU  - Shroff GR
AD  - Division of Cardiology, Department of Medicine, Hennepin Healthcare System, HCMC 
      and University of Minnesota Medical School, Minneapolis, MN, United States. 
      Electronic address: shrof010@umn.edu.
LA  - eng
PT  - Journal Article
DEP - 20220115
PL  - Ireland
TA  - Resuscitation
JT  - Resuscitation
JID - 0332173
SB  - IM
MH  - Coronary Angiography
MH  - *Coronary Occlusion
MH  - Electrocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Observer Variation
MH  - *Out-of-Hospital Cardiac Arrest/diagnosis/etiology
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Coronary angiogram
OT  - Electrocardiogram
OT  - Metabolic abnormalities
OT  - Out of hospital cardiac arrest
COIS- Declaration of Competing Interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2022/01/19 06:00
MHDA- 2022/03/26 06:00
CRDT- 2022/01/18 20:13
PHST- 2021/10/05 00:00 [received]
PHST- 2021/12/18 00:00 [revised]
PHST- 2022/01/06 00:00 [accepted]
PHST- 2022/01/19 06:00 [pubmed]
PHST- 2022/03/26 06:00 [medline]
PHST- 2022/01/18 20:13 [entrez]
AID - S0300-9572(22)00006-5 [pii]
AID - 10.1016/j.resuscitation.2022.01.005 [doi]
PST - ppublish
SO  - Resuscitation. 2022 Mar;172:24-31. doi: 10.1016/j.resuscitation.2022.01.005. Epub 
      2022 Jan 15.