Key result
Post-ROSC STEMI linked to ~12% lower likelihood of favorable one-year neurological outcomes vs non-STEMI.
Why the study?
It remained unclear whether post-return of spontaneous circulation ECG features are useful for predicting outcomes after out-of-hospital cardiac arrest.
Do specific post-ROSC ECG features predict long-term neurological outcome in adult non-traumatic OHCA patients?
Cohort
Yes
Do specific post-ROSC ECG features predict long-term neurological outcome in adult non-traumatic OHCA patients?
Absolute Event Rate: 54% vs 61.6%
Post-ROSC ECG features, specifically wider QRS complex and ST-elevations in inferior leads, can serve as early prognosticators for long-term neurological outcome after out-of-hospital cardiac arrest.
Certain post-ROSC ECG features were associated with worse one-year neurological outcome after OHCA; leaves open their incremental value for early prognostication.
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) has low survival rates worldwide. For the diagnosis of acute coronary syndrome causing OHCA and the identification of patients eligible for immediate coronary angiography, the post-return of spontaneous circulation electrocardiogram (post-ROSC ECG) is crucial. However, it is still unclear whether post-ROSC ECG features also pose a sensible feature for outcome prediction. METHODS: This retrospective study analysed adult non-traumatic OHCA cases with post-ROSC ECGs admitted to one of the three participating centers in Vienna (Austria), Pavia (Italy) and Lugano (Switzerland) between 01/2015 and 12/2018, and reports ECG features, survival and neurological outcome (at hospital discharge and after one year). Univariable and multivariable logistic regression assessed associations between ECG features and neurological outcome. RESULTS: STEMI was diagnosed in 53.5% of post-ROSC ECGs. 68.1% of patients were discharged, with 59.5% having a favorable neurological outcome. One year later, 61.6% of non-STEMI patients had a favorable outcome compared to 54% of STEMI patients. Univariable analysis indicated that ST-elevations in II, III, and aVF, as well as a broader QRS complex significantly influenced neurological outcomes at one year. CONCLUSIONS: ECG after ROSC can identify patients at high risk of death after OHCA earlier than other prognostic methods, not only in terms of short-term mortality, but also in terms of neurological outcome one year after OHCA. Wider QRS complex and ST-elevations in II, III, or aVF were identified as specific prognosticators.
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Schnaubelt et al. (2025) conducted a cohort in Out-of-hospital cardiac arrest (OHCA). STEMI on post-ROSC ECG vs. Non-STEMI on post-ROSC ECG was evaluated on Favorable neurological outcome at one year. STEMI on post-ROSC ECG was associated with worse neurological outcomes at one year compared to non-STEMI (54% vs 61.6% favorable outcome).
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