Associations between common ECG abnormalities and out-of-hospital cardiac arrest

Marc Meller Søndergaard; Jonas Bille Nielsen; Rikke Nørmark Mortensen; Gunnar Gislason; Lars Køber; Freddy Lippert; Claus Graff; Stig Haunsø; Jesper Hastrup Svendsen; Kristian Hay Kragholm; Adrian Holger Pietersen; Bent Struer Lind; Søren Pihlkjær Hjortshøj; Anders Gaarsdal Holst; Johannes Jan Struijk; Christian Torp-Pedersen; Steen Møller Hansen

doi:10.1136/openhrt-2018-000905

Associations between common ECG abnormalities and out-of-hospital cardiac arrest

Marc Meller Søndergaard, Jonas Bille Nielsen, Rikke Nørmark Mortensen, Gunnar Gislason, Lars Køber, Freddy Lippert, Claus Graff, Stig Haunsø, Jesper Hastrup Svendsen, Kristian Hay Kragholm, Adrian Holger Pietersen, Bent Struer Lind, Søren Pihlkjær Hjortshøj, Anders Gaarsdal Holst, Johannes Jan Struijk, Christian Torp-Pedersen, Steen Møller Hansen

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Abstract

Background: Out-of-hospital cardiac arrest (OHCA) is often the first manifestation of unrecognised cardiac disease. ECG abnormalities encountered in primary care settings may be warning signs of OHCA.

Objective: We examined the association between common ECG abnormalities and OHCA in a primary care setting.

Methods: We cross-linked individuals who had an ECG recording between 2001 and 2011 in a primary care setting with the Danish Cardiac Arrest Registry and identified OHCAs of presumed cardiac cause.

Results: A total of 326 227 individuals were included and 2667 (0,8%) suffered an OHCA. In Cox regression analyses, adjusted for age and sex, the following ECG findings were strongly associated with OHCA: ST-depression without concomitant atrial fibrillation (HR 2.79; 95% CI 2.45 to 3.18), left bundle branch block (LBBB; HR 3.44; 95% CI 2.85 to 4.14) and non-specific intraventricular block (NSIB; HR 3.15; 95% CI 2.58 to 3.83). Also associated with OHCA were atrial fibrillation (HR 1.89; 95% CI 1.63 to 2.18), Q-wave (HR 1.75; 95% CI 1.57 to 1.95), Cornell and Sokolow-Lyon criteria for left ventricular hypertrophy (HR 1.56; 95% CI 1.33 to 1.82 and HR 1.27; 95% CI 1.12 to 1.45, respectively), ST-elevation (HR 1.40; 95% CI 1.09 to 1.54) and right bundle branch block (HR 1.29; 95% CI 1.09 to 1.54). The association between ST-depression and OHCA diminished with concomitant atrial fibrillation (HR 1.79; 95% CI 1.42 to 2.24, p < 0.01 for interaction). Among patients suffering from OHCA, without a known cardiac disease at the time of the cardiac arrest, 14.2 % had LBBB, NSIB or ST-depression.

Conclusions: Several common ECG findings obtained from a primary care setting are associated with OHCA.

Original language	English
Article number	e000905
Journal	Open Heart
Volume	6
Issue number	1
ISSN	2398-595X
DOIs	https://doi.org/10.1136/openhrt-2018-000905
Publication status	Published - 1 May 2019

Keywords

ECG
cardiac disease
out-of-hospital cardiac arrest
risk

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http://openheart.bmj.com/content/6/1/e000905.abstractLicence: CC BY 4.0

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Søndergaard, M. M., Nielsen, J. B., Mortensen, R. N., Gislason, G., Køber, L., Lippert, F., Graff, C., Haunsø, S., Svendsen, J. H., Kragholm, K. H., Pietersen, A. H., Lind, B. S., Hjortshøj, S. P., Holst, A. G., Struijk, J. J., Torp-Pedersen, C., & Hansen, S. M. (2019). Associations between common ECG abnormalities and out-of-hospital cardiac arrest. Open Heart, 6(1), Article e000905. https://doi.org/10.1136/openhrt-2018-000905

@article{09572ca58cc34dbdad6e3cd5627dacff,

title = "Associations between common ECG abnormalities and out-of-hospital cardiac arrest",

abstract = "Background: Out-of-hospital cardiac arrest (OHCA) is often the first manifestation of unrecognised cardiac disease. ECG abnormalities encountered in primary care settings may be warning signs of OHCA.Objective: We examined the association between common ECG abnormalities and OHCA in a primary care setting.Methods: We cross-linked individuals who had an ECG recording between 2001 and 2011 in a primary care setting with the Danish Cardiac Arrest Registry and identified OHCAs of presumed cardiac cause.Results: A total of 326 227 individuals were included and 2667 (0,8%) suffered an OHCA. In Cox regression analyses, adjusted for age and sex, the following ECG findings were strongly associated with OHCA: ST-depression without concomitant atrial fibrillation (HR 2.79; 95% CI 2.45 to 3.18), left bundle branch block (LBBB; HR 3.44; 95% CI 2.85 to 4.14) and non-specific intraventricular block (NSIB; HR 3.15; 95% CI 2.58 to 3.83). Also associated with OHCA were atrial fibrillation (HR 1.89; 95% CI 1.63 to 2.18), Q-wave (HR 1.75; 95% CI 1.57 to 1.95), Cornell and Sokolow-Lyon criteria for left ventricular hypertrophy (HR 1.56; 95% CI 1.33 to 1.82 and HR 1.27; 95% CI 1.12 to 1.45, respectively), ST-elevation (HR 1.40; 95% CI 1.09 to 1.54) and right bundle branch block (HR 1.29; 95% CI 1.09 to 1.54). The association between ST-depression and OHCA diminished with concomitant atrial fibrillation (HR 1.79; 95% CI 1.42 to 2.24, p < 0.01 for interaction). Among patients suffering from OHCA, without a known cardiac disease at the time of the cardiac arrest, 14.2 % had LBBB, NSIB or ST-depression.Conclusions: Several common ECG findings obtained from a primary care setting are associated with OHCA.",

keywords = "ECG, cardiac disease, out-of-hospital cardiac arrest, risk",

author = "S{\o}ndergaard, {Marc Meller} and Nielsen, {Jonas Bille} and Mortensen, {Rikke N{\o}rmark} and Gunnar Gislason and Lars K{\o}ber and Freddy Lippert and Claus Graff and Stig Hauns{\o} and Svendsen, {Jesper Hastrup} and Kragholm, {Kristian Hay} and Pietersen, {Adrian Holger} and Lind, {Bent Struer} and Hjortsh{\o}j, {S{\o}ren Pihlkj{\ae}r} and Holst, {Anders Gaarsdal} and Struijk, {Johannes Jan} and Christian Torp-Pedersen and Hansen, {Steen M{\o}ller}",

year = "2019",

month = may,

day = "1",

doi = "10.1136/openhrt-2018-000905",

language = "English",

volume = "6",

journal = "Open Heart",

issn = "2398-595X",

publisher = "BMJ ",

number = "1",

}

Søndergaard, MM, Nielsen, JB, Mortensen, RN, Gislason, G, Køber, L, Lippert, F, Graff, C, Haunsø, S, Svendsen, JH, Kragholm, KH, Pietersen, AH, Lind, BS, Hjortshøj, SP, Holst, AG, Struijk, JJ , Torp-Pedersen, C & Hansen, SM 2019, 'Associations between common ECG abnormalities and out-of-hospital cardiac arrest', Open Heart, vol. 6, no. 1, e000905. https://doi.org/10.1136/openhrt-2018-000905

TY - JOUR

T1 - Associations between common ECG abnormalities and out-of-hospital cardiac arrest

AU - Søndergaard, Marc Meller

AU - Nielsen, Jonas Bille

AU - Mortensen, Rikke Nørmark

AU - Gislason, Gunnar

AU - Køber, Lars

AU - Lippert, Freddy

AU - Graff, Claus

AU - Haunsø, Stig

AU - Svendsen, Jesper Hastrup

AU - Kragholm, Kristian Hay

AU - Pietersen, Adrian Holger

AU - Lind, Bent Struer

AU - Hjortshøj, Søren Pihlkjær

AU - Holst, Anders Gaarsdal

AU - Struijk, Johannes Jan

AU - Torp-Pedersen, Christian

AU - Hansen, Steen Møller

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: Out-of-hospital cardiac arrest (OHCA) is often the first manifestation of unrecognised cardiac disease. ECG abnormalities encountered in primary care settings may be warning signs of OHCA.Objective: We examined the association between common ECG abnormalities and OHCA in a primary care setting.Methods: We cross-linked individuals who had an ECG recording between 2001 and 2011 in a primary care setting with the Danish Cardiac Arrest Registry and identified OHCAs of presumed cardiac cause.Results: A total of 326 227 individuals were included and 2667 (0,8%) suffered an OHCA. In Cox regression analyses, adjusted for age and sex, the following ECG findings were strongly associated with OHCA: ST-depression without concomitant atrial fibrillation (HR 2.79; 95% CI 2.45 to 3.18), left bundle branch block (LBBB; HR 3.44; 95% CI 2.85 to 4.14) and non-specific intraventricular block (NSIB; HR 3.15; 95% CI 2.58 to 3.83). Also associated with OHCA were atrial fibrillation (HR 1.89; 95% CI 1.63 to 2.18), Q-wave (HR 1.75; 95% CI 1.57 to 1.95), Cornell and Sokolow-Lyon criteria for left ventricular hypertrophy (HR 1.56; 95% CI 1.33 to 1.82 and HR 1.27; 95% CI 1.12 to 1.45, respectively), ST-elevation (HR 1.40; 95% CI 1.09 to 1.54) and right bundle branch block (HR 1.29; 95% CI 1.09 to 1.54). The association between ST-depression and OHCA diminished with concomitant atrial fibrillation (HR 1.79; 95% CI 1.42 to 2.24, p < 0.01 for interaction). Among patients suffering from OHCA, without a known cardiac disease at the time of the cardiac arrest, 14.2 % had LBBB, NSIB or ST-depression.Conclusions: Several common ECG findings obtained from a primary care setting are associated with OHCA.

AB - Background: Out-of-hospital cardiac arrest (OHCA) is often the first manifestation of unrecognised cardiac disease. ECG abnormalities encountered in primary care settings may be warning signs of OHCA.Objective: We examined the association between common ECG abnormalities and OHCA in a primary care setting.Methods: We cross-linked individuals who had an ECG recording between 2001 and 2011 in a primary care setting with the Danish Cardiac Arrest Registry and identified OHCAs of presumed cardiac cause.Results: A total of 326 227 individuals were included and 2667 (0,8%) suffered an OHCA. In Cox regression analyses, adjusted for age and sex, the following ECG findings were strongly associated with OHCA: ST-depression without concomitant atrial fibrillation (HR 2.79; 95% CI 2.45 to 3.18), left bundle branch block (LBBB; HR 3.44; 95% CI 2.85 to 4.14) and non-specific intraventricular block (NSIB; HR 3.15; 95% CI 2.58 to 3.83). Also associated with OHCA were atrial fibrillation (HR 1.89; 95% CI 1.63 to 2.18), Q-wave (HR 1.75; 95% CI 1.57 to 1.95), Cornell and Sokolow-Lyon criteria for left ventricular hypertrophy (HR 1.56; 95% CI 1.33 to 1.82 and HR 1.27; 95% CI 1.12 to 1.45, respectively), ST-elevation (HR 1.40; 95% CI 1.09 to 1.54) and right bundle branch block (HR 1.29; 95% CI 1.09 to 1.54). The association between ST-depression and OHCA diminished with concomitant atrial fibrillation (HR 1.79; 95% CI 1.42 to 2.24, p < 0.01 for interaction). Among patients suffering from OHCA, without a known cardiac disease at the time of the cardiac arrest, 14.2 % had LBBB, NSIB or ST-depression.Conclusions: Several common ECG findings obtained from a primary care setting are associated with OHCA.

KW - ECG

KW - cardiac disease

KW - out-of-hospital cardiac arrest

KW - risk

UR - http://www.scopus.com/inward/record.url?scp=85066016299&partnerID=8YFLogxK

U2 - 10.1136/openhrt-2018-000905

DO - 10.1136/openhrt-2018-000905

M3 - Journal article

C2 - 31217990

SN - 2398-595X

VL - 6

JO - Open Heart

JF - Open Heart

IS - 1

M1 - e000905

ER -

Associations between common ECG abnormalities and out-of-hospital cardiac arrest

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Associations between common ECG abnormalities and out-of-hospital cardiac arrest

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