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

Michiel Hulleman, David D Salcido, James J Menegazzi, Patrick C Souverein, Hanno L Tan, Marieke T Blom, Rudolph Willem Koster

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)125-131
Number of pages7
JournalResuscitation
Volume120
DOIs
Publication statusPublished - Nov 2017

Keywords

  • Cardiopulmonary resuscitation
  • Heart arrest
  • Sudden cardiac death
  • Arrhythmia
  • ST-segment elevation myocardial infarction
  • Quantitative waveform measures
  • Ventricular fibrillation

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