TY - JOUR
T1 - Predictive value of amplitude spectrum area of ventricular fibrillation waveform in patients with acute or previous myocardial infarction in out-of-hospital cardiac arrest
AU - Hulleman, Michiel
AU - Salcido, David D.
AU - Menegazzi, James J.
AU - Souverein, Patrick C.
AU - Tan, Hanno L.
AU - Blom, Marieke T.
AU - Koster, Rudolph W.
N1 - Funding Information: M. Hulleman is supported by a grant from the Netherlands Heart Foundation (grant 2013T034 ). D.D. Salcido is supported by the following research grants; NHLBI 1R01HL117979-01A1 (PI: Menegazzi, In-Kind), NHLBI 5K12HL109068-04 (PI: Yealy) and Laerdal Foundation Grant (PI: Salcido). H.L. Tan and M.T. Blom are supported by the Netherlands CardioVascular Research Initiative : the Dutch Heart Foundation , Dutch Federation of University Medical Centres , the Netherlands Organisation for Health Research and Development , and the Royal Netherlands Academy of Sciences (PREDICT project). H.L. Tan was also supported by the Netherlands Organization for Scientific Research (NWO, grant ZonMW Vici 918.86.616 ) and the Dutch Medicines Evaluation Board (MEB/CBG) . None of the funders were involved in the study design, data collection, analysis, interpretation or in writing of the manuscript. Publisher Copyright: © 2017 The Authors
PY - 2017/11
Y1 - 2017/11
N2 - 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 (8.4 mV-Hz [3.7–16.5] vs. 12.3 mV-Hz [5.6–23.0]; P < 0.001), but previous MI was not (9.5 mV-Hz [3.9–18.0] vs 10.6 mV-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.
AB - 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 (8.4 mV-Hz [3.7–16.5] vs. 12.3 mV-Hz [5.6–23.0]; P < 0.001), but previous MI was not (9.5 mV-Hz [3.9–18.0] vs 10.6 mV-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.
KW - Arrhythmia
KW - Cardiopulmonary resuscitation
KW - Heart arrest
KW - Quantitative waveform measures
KW - ST-segment elevation myocardial infarction
KW - Sudden cardiac death
KW - Ventricular fibrillation
UR - http://www.scopus.com/inward/record.url?scp=85029149473&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.resuscitation.2017.08.219
DO - https://doi.org/10.1016/j.resuscitation.2017.08.219
M3 - Article
C2 - 28844935
SN - 0300-9572
VL - 120
SP - 125
EP - 131
JO - Resuscitation
JF - Resuscitation
ER -