Early prediction of ventricular fibrillation using electrocardiographic characteristics in prehospital suspected ST-segment elevation myocardial infarction: a case-control study.
ECG interpretation
Predictors
Prehospital
Risk Factors
STEMI
Ventricular fibrillation
Journal
CJEM
ISSN: 1481-8043
Titre abrégé: CJEM
Pays: England
ID NLM: 100893237
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
11
01
2023
accepted:
23
07
2023
medline:
12
9
2023
pubmed:
13
8
2023
entrez:
12
8
2023
Statut:
ppublish
Résumé
Our objective was to determine characteristics of electrocardiograms (ECG) that predict ventricular fibrillation (VF) among prehospital patients with suspected ST-segment elevation myocardial infarction (STEMI) in Québec. We performed a matched case-control study of prehospital adult suspected with STEMI. Patients in case group (STEMI/VF+) were matched with controls (STEMI/VF-) for age and sex and then compared for ECG characteristics, including ST-segment elevations (STE) and depressions (STD), duration of interval complexes, general characteristics, and several calculated variables. Logistic regression was used to measure the association between ECG characteristics and VF development. Overall, 310 prehospital patients with suspected STEMI were included in the analysis (case group, n = 155; control group, n = 155). We confirmed that the presence of TW-pattern complex (OR 7.0, 95% CI 1.55-31.58), premature ventricular contraction (PVC) (OR 5.5, 95% CI 2.04-14.82), and STE in V2-V6 (OR 3.8, 95% CI 1.21-11.74) were electrocardiographic predictors of VF. We also observed that STD in V3-V5 (OR 6.5, 95% CI 1.42-29.39), atrial fibrillation (AF) ≥ 100 beats per minute (bpm) (OR 6.3, 95% CI 1.80-21.90), the combination of STE in V4 and V5, and STD in II, III and aVF (OR 4.8, 95% CI 1.01-22.35), and the presence of STD in ≥ 6 leads (OR 4.2, 95% CI 1.33-13.13) were also associated with VF development. Finally, simultaneous association of 2 (OR 2.3, 95% CI 1.13-4.06) and 3 (OR 11.6, 95% CI 3.22-41.66) predictors showed significant association with VF. In addition to some already known predictors, we have identified several ECG findings associated with the development of VF in patients with suspected STEMI. Early identification of patients with STEMI at increased risk of VF should help EMS providers anticipate adverse events and encourage use of defibrillation pads. RéSUMé: OBJECTIF: Notre objectif était de déterminer les caractéristiques des électrocardiogrammes (ECG) qui prédisent la fibrillation ventriculaire (FV) chez les patients préhospitaliers suspectés d’infarctus du myocarde à élévation du segment ST (STEMI) au Québec. MéTHODES: Nous avons effectué une étude cas-témoin appariée de l’adulte préhospitalier suspecté avec STEMI. Les patients du groupe de cas (STEMI/VF+) ont été appariés avec les témoins (STEMI/VF-) pour l’âge et le sexe, puis comparés pour les caractéristiques ECG, y compris les élévations du segment ST (STE) et les dépressions (STD), la durée des complexes d’intervalles, les caractéristiques générales et plusieurs variables calculées. La régression logistique a été utilisée pour mesurer l’association entre les caractéristiques de l’ECG et le développement de la FV. RéSULTATS: Dans l’ensemble, 310 patients préhospitaliers présentant un STEMI suspecté ont été inclus dans l’analyse (groupe de cas, n = 155; groupe témoin, n = 155). Nous avons confirmé que la présence de complexes TW (OR 7,0, IC à 95% 1,55–31,58), de contraction ventriculaire prématurée (PVC) (OR 5,5, IC à 95% 2,04–14,82) et de STE dans V2–V6 (OR 3,8, IC à 95% 1,21–11,74) étaient des prédicteurs électrocardiographiques de la FV. Nous avons également observé que STD dans V3-V5 (OR 6,5, IC à 95% 1,42–29,39), fibrillation auriculaire (AF) 100 battements par minute (bpm) (OR 6,3, IC à 95% 1,80–21,90), la combinaison de STE dans V4 et V5, et STD dans II, III et aVF (OR 4,8, IC à 95% 1,01–22,35) et la présence de STD dans 6 dérivations (OR 4.2, IC à 95% 1.33–13.13) ont également été associés au développement de la FV. Enfin, l’association simultanée de 2 (OR 2,3, IC à 95% 1,13–4,06) et 3 (OR 11,6, IC à 95% 3,22–41,66) prédicteurs a montré une association significative avec la FV. CONCLUSIONS: En plus de certains prédicteurs déjà connus, nous avons identifié plusieurs résultats d’ECG associés au développement de la FV chez des patients présentant une STEMI suspectée. L’identification précoce des patients atteints de STEMI à risque accru de FV devrait aider les fournisseurs de soins médicaux d’urgence à anticiper les événements indésirables et à encourager l’utilisation de tampons de défibrillation.
Autres résumés
Type: Publisher
(fre)
RéSUMé: OBJECTIF: Notre objectif était de déterminer les caractéristiques des électrocardiogrammes (ECG) qui prédisent la fibrillation ventriculaire (FV) chez les patients préhospitaliers suspectés d’infarctus du myocarde à élévation du segment ST (STEMI) au Québec. MéTHODES: Nous avons effectué une étude cas-témoin appariée de l’adulte préhospitalier suspecté avec STEMI. Les patients du groupe de cas (STEMI/VF+) ont été appariés avec les témoins (STEMI/VF-) pour l’âge et le sexe, puis comparés pour les caractéristiques ECG, y compris les élévations du segment ST (STE) et les dépressions (STD), la durée des complexes d’intervalles, les caractéristiques générales et plusieurs variables calculées. La régression logistique a été utilisée pour mesurer l’association entre les caractéristiques de l’ECG et le développement de la FV. RéSULTATS: Dans l’ensemble, 310 patients préhospitaliers présentant un STEMI suspecté ont été inclus dans l’analyse (groupe de cas, n = 155; groupe témoin, n = 155). Nous avons confirmé que la présence de complexes TW (OR 7,0, IC à 95% 1,55–31,58), de contraction ventriculaire prématurée (PVC) (OR 5,5, IC à 95% 2,04–14,82) et de STE dans V2–V6 (OR 3,8, IC à 95% 1,21–11,74) étaient des prédicteurs électrocardiographiques de la FV. Nous avons également observé que STD dans V3-V5 (OR 6,5, IC à 95% 1,42–29,39), fibrillation auriculaire (AF) 100 battements par minute (bpm) (OR 6,3, IC à 95% 1,80–21,90), la combinaison de STE dans V4 et V5, et STD dans II, III et aVF (OR 4,8, IC à 95% 1,01–22,35) et la présence de STD dans 6 dérivations (OR 4.2, IC à 95% 1.33–13.13) ont également été associés au développement de la FV. Enfin, l’association simultanée de 2 (OR 2,3, IC à 95% 1,13–4,06) et 3 (OR 11,6, IC à 95% 3,22–41,66) prédicteurs a montré une association significative avec la FV. CONCLUSIONS: En plus de certains prédicteurs déjà connus, nous avons identifié plusieurs résultats d’ECG associés au développement de la FV chez des patients présentant une STEMI suspectée. L’identification précoce des patients atteints de STEMI à risque accru de FV devrait aider les fournisseurs de soins médicaux d’urgence à anticiper les événements indésirables et à encourager l’utilisation de tampons de défibrillation.
Identifiants
pubmed: 37572268
doi: 10.1007/s43678-023-00565-4
pii: 10.1007/s43678-023-00565-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
728-735Informations de copyright
© 2023. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).
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