Predictive value of amplitude spectrum area of ventricular fibrillation waveform in patients with acute or previous myocardial infarction in out-of-hospital cardiac arrest.

Abstract

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 (8.4mV-Hz [3.7-16.5] vs. 12.3mV-Hz [5.6-23.0]; P<0.001), but previous MI was not (9.5mV-Hz [3.9-18.0] vs 10.6mV-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.

• Authors: Michiel Hulleman, David D Salcido, James J Menegazzi, Patrick C Souverein, Hanno L Tan, Marieke T Blom, Rudolph W Koster
• Journal: Resuscitation (Resuscitation) Vol. 120 Pg. 125-131 (11 2017) ISSN: 1873-1570 [Electronic] Ireland
• PMID: 28844935 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Topics

• Aged
• Cardiopulmonary Resuscitation (methods)
• Electric Countershock
• Electrocardiography
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Myocardial Infarction (complications, epidemiology, physiopathology)
• Out-of-Hospital Cardiac Arrest (etiology, mortality)
• Predictive Value of Tests
• Prospective Studies
• Registries
• Ventricular Fibrillation (complications, epidemiology, physiopathology)