Key result
ECG abnormalities like prolonged QTc and LBBB are linked to higher 5-year OHCA risk.
Why the study?
Electrocardiograms potentially represent strong risk predictors, but their role in risk stratification for out-of-hospital cardiac arrest is unclear.
Are specific ECG abnormalities associated with an increased 5-year risk of out-of-hospital cardiac arrest compared to a normal ECG in a general patient population?
Cohort (n=2,155,155)
Yes
Are specific ECG abnormalities associated with an increased 5-year risk of out-of-hospital cardiac arrest compared to a normal ECG in a general patient population?
A wide range of common ECG abnormalities, particularly QTc prolongation and left posterior fascicular block, serve as significant independent predictors for 5-year out-of-hospital cardiac arrest risk.
BACKGROUND Electrocardiograms (ECGs) potentially represent strong risk predictors, but their role in risk stratification for out-of-hospital cardiac arrest (OHCA) is unclear. OBJECTIVE This study aimed to assess 5-year OHCA risk for different ECG abnormalities. METHODS Data on patients and their respective first-recorded ECG, from hospital or ambulance setting, were retrieved from Danish Nationwide Electrocardiogram Cohort and Danish Cardiac Arrest Registry. Patients were followed from ECG recording until OHCA, death from other causes, emigration, or end-of-study. Cox proportional hazards models were used to estimate rates of OHCA and death from other causes, adjusted for comorbidities and medication use, and then utilized to estimate 5-year OHCA risk. RESULTS This study included 2,155,155 patients. Five-year OHCA risk for patients with normal ECGs was 0.50% [95% CI: 0.49-0.51%]. Following ECG abnormalities were associated with significantly higher 5-year OHCA risk: atrial fibrillation (0.61% [95% CI: 0.58-0.64%]), left bundle branch block (0.73% [95% CI: 0.68-0.78%]), intraventricular conduction delay (0.68 [95% CI: 0.63-0.73]), left posterior fascicular block (0.87% [95% CI: 0.67-1.06%]), Q-wave (0.59% [95% CI: 0.57-0.61%]), ST-depression (0.67% [95% CI: 0.64-0.71%], left ventricular hypertrophy (0.74% [95% CI: 0.71-0.77%]) and QTc prolongation (0.84% [95% CI: 0.81-0.86%]). Corresponding results were observed regarding relative risk. CONCLUSIONS This nationwide study of over two million patients, spanning almost 20 years, showed that several ECG abnormalities were associated with increased 5-year risk of OHCA.
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Hindborg et al. (2026) conducted a cohort in Risk of out-of-hospital cardiac arrest (n=2,155,155). Electrocardiogram (ECG) abnormalities vs. Normal ECGs was evaluated on 5-year risk of out-of-hospital cardiac arrest (OHCA). Compared to normal ECGs (0.50%), ECG abnormalities such as QTc prolongation (0.84%) and left bundle branch block (0.73%) were associated with a significantly higher 5-year risk of OHCA.
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