Key result
The simple SACAF score effectively discriminated VT/VF from non-VT/VF bystander-witnessed out-of-hospital cardiac arrests with an AUC of 0.739 compared to 0.474 for the modified CHA2DS2-VASc score.
Why the study?
Out-of-hospital cardiac arrest remains a major health threat, and patients presenting with initial shockable VT/VF rhythm have better survival, prompting the need for a simple score to discriminate VT/VF from non-VT/VF events.
Does the SACAF score improve discrimination of VT/VF from non-VT/VF OHCAs compared to the modified CHA2DS2-VASc score in bystander-witnessed OHCA patients?
Cohort (n=461)
Yes
Does the SACAF score improve discrimination of VT/VF from non-VT/VF OHCAs compared to the modified CHA2DS2-VASc score in bystander-witnessed OHCA patients?
A novel, simple SACAF score (male sex, age ≤ 65, cardiovascular disease, AF) effectively discriminates shockable VT/VF rhythms from non-shockable rhythms in bystander-witnessed out-of-hospital cardiac arrest.
Answers are grounded in this paper and cite their sources.
May aid prehospital rhythm prediction in witnessed OHCA; leaves open prospective validation before clinical adoption.
Out-of-hospital cardiac arrest (OHCA) remains a major threat to public health worldwide. OHCA patients presenting initial shockable ventricular tachycardia/ventricular fibrillation (VT/VF) rhythm have a better survival rate. We sought to develop a simple SACAF score to discriminate VT/VF from non-VT/VF OHCAs based on the Taiwan multicenter hospital-based registry database. We analyzed the in- and pre-hospital data, including demographics, baseline comorbidities, response times, automated external defibrillator information, and the 12-lead ECG recording closest to the OHCA event in bystander-witnessed OHCA patients. Among the 461 study patients, male sex (OR 2.54, 95% CI = 1.32–4.88, P = 0.005), age ≤ 65 years (OR 2.78, 95% CI = 1.64–4.70, P < 0.001), cardiovascular diseases (OR 2.97, 95% CI = 1.73–5.11, P < 0.001), and atrial fibrillation (AF) (OR 2.36, 95% CI = 1.17–4.76, P = 0.017) were independent risk factors for VT/VF OHCA (n = 81) compared with non-VT/VF OHCA (n = 380). A composite SACAF score was developed (male S ex, A ge ≤ 65 years, C ardiovascular diseases, and AF ) and compared with the performance of a modified CHA 2 DS 2 -VASc score ( C ardiovascular diseases, H ypertension, A ge ≥ 75 years, D iabetes, previous S troke, V ascular disease, A ge 65–74 years, female S ex c ategory). The area under the receiver operating characteristic curve (AUC) of the SACAF was 0.739 (95% CI = 0.681–0.797, P < 0.001), whereas the AUC of the modified CHA 2 DS 2 -VASc was 0.474 (95% CI = 0.408–0.541, P = 0.464). A SACAF score of ≥ 2 was useful in discriminating VT/VF from non-VT/VF OHCAs with a sensitivity of 0.75 and a specificity of 0.60. In conclusion, the simple SACAF score appears to be useful in discriminating VT/VF from non-VT/VF bystander-witnessed OHCAs and the findings may also shed light on future mechanistic evaluation.
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Wu et al. (2021) conducted a cohort in Bystander-witnessed out-of-hospital cardiac arrest (OHCA) (n=461). SACAF score vs. Modified CHA2DS2-VASc score was evaluated on Discrimination of VT/VF from non-VT/VF OHCAs (AUC) (95% CI 0.681-0.797, p=<0.001). The simple SACAF score effectively discriminated VT/VF from non-VT/VF bystander-witnessed out-of-hospital cardiac arrests with an AUC of 0.739 compared to 0.474 for the modified CHA2DS2-VASc score.
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