Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality - A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators

doi:10.1097/CCM.0000000000006619

Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality - A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators

Abstract

OBJECTIVES: The use of electrocardiograms for predicting significant coronary lesions and mortality in patients with successfully resuscitated out-of-hospital cardiac arrest (OHCA) without ST-segment elevation has not been defined yet. The objective of this study was to investigate the association and predictive value of various standardized 12-lead electrocardiogram patterns in patients with successfully resuscitated OHCA and no ST-segment elevations on the presence of significant coronary lesions (diagnostic performance) and 30-day mortality (prognostic performance).

DESIGN: Predefined subanalysis of the Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) trial.

SETTING: Multicenter, international randomized controlled trial across 31 centers.

PATIENTS: Adult patients with successfully resuscitated OHCA and no ST-segment elevations.

INTERVENTIONS: The first recorded electrocardiogram after the return of spontaneous circulation (ROSC) at hospital admission was analyzed by experienced physicians.

MEASUREMENTS AND MAIN RESULTS: Significant coronary lesions and 30-day mortality. In total, 412 patients with a coronary angiography were included, of which 163 (40%) had significant coronary lesions. No electrocardiogram pattern was identified as a predictor of significant coronary lesions. In the total cohort of patients with and without coronary angiography, right bundle branch blocks (BBBs), prolonged intrinsicoid deflection times, and intrinsicoid deflections in right BBB were strong, independent predictors of 30-day mortality. The "intrinsicoid deflection" is the sharp upward deflection in the QRS complex of an electrocardiogram. The "intrinsicoid deflection time" is the interval from the start of the QRS complex to the peak of the R wave. The predictive performance for significant coronary lesions was poor across all electrocardiogram patterns and better for 30-day mortality.

CONCLUSIONS: Standardized 12-lead electrocardiogram patterns after ROSC at hospital admission in patients with successfully resuscitated OHCA without ST-segment elevations have poor predictive performance for the presence of significant coronary lesions. Different QRS-related patterns might identify patients with higher risk of short-term mortality.

Originalsprache	Englisch
Aufsatznummer	6619
Zeitschrift	Critical Care Medicine
Jahrgang	53
Ausgabenummer	4
Seiten (von - bis)	e916-e927
ISSN	0090-3493
DOIs	https://doi.org/10.1097/CCM.0000000000006619
Publikationsstatus	Veröffentlicht - 01.04.2025

Fördermittel

Dr. Skurk received funding from Abiomed. Dr. Hassager received funding from BD; his institution received funding from the Novo Nordisk Foundation, the Lundbeck Foundation, and the Danish Heart Foundation. Dr. Preusch\u2019s institution received funding for patient study documentation. Dr. Jobs received support for article research from the National Institutes of Health; he disclosed work for hire. Dr. Waha received funding from Zoll/TherOX. Dr. P\u00F6ss\u2019 institution received funding from the German Cardiac Society, the German Heart Foundation, the Schwiete Foundation, and the Maquet Cardiopulmonary. Dr. Freund\u2019s institution received funding from the German Center for Cardiovascular Research. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Träger	Trägernummer
Deutsche Gesellschaft für Kardiologie-Herz und Kreislaufforschung.
Deutsches Zentrum für Herz-Kreislaufforschung
Hjerteforeningen
Lundbeck Foundation
Schwiete Foundation
Novo Nordisk Fonden
Deutsche Herzstiftung
National Institutes of Health

UN SDGs

Dieser Output leistet einen Beitrag zu folgendem(n) Ziel(en) für nachhaltige Entwicklung

SDG 3 – Gesundheit und Wohlergehen

Strategische Forschungsbereiche und Zentren

Zentren: Universitäres Herzzentrum Lübeck (UHZL)

DFG-Fachsystematik

2.22-12 Kardiologie, Angiologie

Dokumente

10.1097/CCM.0000000000006619

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Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators (2025). Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality - A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial. Critical Care Medicine, 53(4), e916-e927. Artikel 6619. https://doi.org/10.1097/CCM.0000000000006619

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators. / Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality - A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial. in: Critical Care Medicine. 2025 ; Jahrgang 53, Nr. 4. S. e916-e927.

@article{fda538a315ab4c7d8dcf0cd6c9c0a223,

title = "Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality - A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial",

abstract = "OBJECTIVES: The use of electrocardiograms for predicting significant coronary lesions and mortality in patients with successfully resuscitated out-of-hospital cardiac arrest (OHCA) without ST-segment elevation has not been defined yet. The objective of this study was to investigate the association and predictive value of various standardized 12-lead electrocardiogram patterns in patients with successfully resuscitated OHCA and no ST-segment elevations on the presence of significant coronary lesions (diagnostic performance) and 30-day mortality (prognostic performance).DESIGN: Predefined subanalysis of the Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) trial.SETTING: Multicenter, international randomized controlled trial across 31 centers.PATIENTS: Adult patients with successfully resuscitated OHCA and no ST-segment elevations.INTERVENTIONS: The first recorded electrocardiogram after the return of spontaneous circulation (ROSC) at hospital admission was analyzed by experienced physicians.MEASUREMENTS AND MAIN RESULTS: Significant coronary lesions and 30-day mortality. In total, 412 patients with a coronary angiography were included, of which 163 (40\%) had significant coronary lesions. No electrocardiogram pattern was identified as a predictor of significant coronary lesions. In the total cohort of patients with and without coronary angiography, right bundle branch blocks (BBBs), prolonged intrinsicoid deflection times, and intrinsicoid deflections in right BBB were strong, independent predictors of 30-day mortality. The {"}intrinsicoid deflection{"} is the sharp upward deflection in the QRS complex of an electrocardiogram. The {"}intrinsicoid deflection time{"} is the interval from the start of the QRS complex to the peak of the R wave. The predictive performance for significant coronary lesions was poor across all electrocardiogram patterns and better for 30-day mortality.CONCLUSIONS: Standardized 12-lead electrocardiogram patterns after ROSC at hospital admission in patients with successfully resuscitated OHCA without ST-segment elevations have poor predictive performance for the presence of significant coronary lesions. Different QRS-related patterns might identify patients with higher risk of short-term mortality.",

author = "\{Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators\} and Tharusan Thevathasan and Julia Claus and Michelle Ro{\ss}berg and Carsten Skurk and Stephan Fichtlscherer and Ibrahim Akin and Georg Fuernau and Christian Hassager and Uwe Zeymer and Preusch, \{Michael R\} and Tobias Graf and Hans-Josef Feistritzer and Alexander Jobs and \{de Waha\}, Suzanne and Holger Thiele and Steffen Desch and Janine P{\"o}ss and Anne Freund",

year = "2025",

month = apr,

day = "1",

doi = "10.1097/CCM.0000000000006619",

language = "English",

volume = "53",

pages = "e916--e927",

journal = "Critical Care Medicine",

issn = "0090-3493",

publisher = "Lippincott Williams and Wilkins",

number = "4",

}

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators 2025, 'Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality - A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial', Critical Care Medicine, Jg. 53, Nr. 4, 6619, S. e916-e927. https://doi.org/10.1097/CCM.0000000000006619

Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality - A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial. / Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators.
in: Critical Care Medicine, Jahrgang 53, Nr. 4, 6619, 01.04.2025, S. e916-e927.

Publikation: Beiträge in Fachzeitschriften › Zeitschriftenaufsätze › Forschung › Begutachtung

TY - JOUR

T1 - Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality - A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial

AU - Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators

AU - Thevathasan, Tharusan

AU - Claus, Julia

AU - Roßberg, Michelle

AU - Skurk, Carsten

AU - Fichtlscherer, Stephan

AU - Akin, Ibrahim

AU - Fuernau, Georg

AU - Hassager, Christian

AU - Zeymer, Uwe

AU - Preusch, Michael R

AU - Graf, Tobias

AU - Feistritzer, Hans-Josef

AU - Jobs, Alexander

AU - de Waha, Suzanne

AU - Thiele, Holger

AU - Desch, Steffen

AU - Pöss, Janine

AU - Freund, Anne

PY - 2025/4/1

Y1 - 2025/4/1

N2 - OBJECTIVES: The use of electrocardiograms for predicting significant coronary lesions and mortality in patients with successfully resuscitated out-of-hospital cardiac arrest (OHCA) without ST-segment elevation has not been defined yet. The objective of this study was to investigate the association and predictive value of various standardized 12-lead electrocardiogram patterns in patients with successfully resuscitated OHCA and no ST-segment elevations on the presence of significant coronary lesions (diagnostic performance) and 30-day mortality (prognostic performance).DESIGN: Predefined subanalysis of the Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) trial.SETTING: Multicenter, international randomized controlled trial across 31 centers.PATIENTS: Adult patients with successfully resuscitated OHCA and no ST-segment elevations.INTERVENTIONS: The first recorded electrocardiogram after the return of spontaneous circulation (ROSC) at hospital admission was analyzed by experienced physicians.MEASUREMENTS AND MAIN RESULTS: Significant coronary lesions and 30-day mortality. In total, 412 patients with a coronary angiography were included, of which 163 (40%) had significant coronary lesions. No electrocardiogram pattern was identified as a predictor of significant coronary lesions. In the total cohort of patients with and without coronary angiography, right bundle branch blocks (BBBs), prolonged intrinsicoid deflection times, and intrinsicoid deflections in right BBB were strong, independent predictors of 30-day mortality. The "intrinsicoid deflection" is the sharp upward deflection in the QRS complex of an electrocardiogram. The "intrinsicoid deflection time" is the interval from the start of the QRS complex to the peak of the R wave. The predictive performance for significant coronary lesions was poor across all electrocardiogram patterns and better for 30-day mortality.CONCLUSIONS: Standardized 12-lead electrocardiogram patterns after ROSC at hospital admission in patients with successfully resuscitated OHCA without ST-segment elevations have poor predictive performance for the presence of significant coronary lesions. Different QRS-related patterns might identify patients with higher risk of short-term mortality.

AB - OBJECTIVES: The use of electrocardiograms for predicting significant coronary lesions and mortality in patients with successfully resuscitated out-of-hospital cardiac arrest (OHCA) without ST-segment elevation has not been defined yet. The objective of this study was to investigate the association and predictive value of various standardized 12-lead electrocardiogram patterns in patients with successfully resuscitated OHCA and no ST-segment elevations on the presence of significant coronary lesions (diagnostic performance) and 30-day mortality (prognostic performance).DESIGN: Predefined subanalysis of the Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) trial.SETTING: Multicenter, international randomized controlled trial across 31 centers.PATIENTS: Adult patients with successfully resuscitated OHCA and no ST-segment elevations.INTERVENTIONS: The first recorded electrocardiogram after the return of spontaneous circulation (ROSC) at hospital admission was analyzed by experienced physicians.MEASUREMENTS AND MAIN RESULTS: Significant coronary lesions and 30-day mortality. In total, 412 patients with a coronary angiography were included, of which 163 (40%) had significant coronary lesions. No electrocardiogram pattern was identified as a predictor of significant coronary lesions. In the total cohort of patients with and without coronary angiography, right bundle branch blocks (BBBs), prolonged intrinsicoid deflection times, and intrinsicoid deflections in right BBB were strong, independent predictors of 30-day mortality. The "intrinsicoid deflection" is the sharp upward deflection in the QRS complex of an electrocardiogram. The "intrinsicoid deflection time" is the interval from the start of the QRS complex to the peak of the R wave. The predictive performance for significant coronary lesions was poor across all electrocardiogram patterns and better for 30-day mortality.CONCLUSIONS: Standardized 12-lead electrocardiogram patterns after ROSC at hospital admission in patients with successfully resuscitated OHCA without ST-segment elevations have poor predictive performance for the presence of significant coronary lesions. Different QRS-related patterns might identify patients with higher risk of short-term mortality.

UR - https://www.scopus.com/pages/publications/86000569883

UR - https://www.mendeley.com/catalogue/6a666d2b-545a-38df-81c2-26194ec9d8cb/

U2 - 10.1097/CCM.0000000000006619

DO - 10.1097/CCM.0000000000006619

M3 - Journal articles

C2 - 39992171

SN - 0090-3493

VL - 53

SP - e916-e927

JO - Critical Care Medicine

JF - Critical Care Medicine

IS - 4

M1 - 6619

ER -

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) Investigators. Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality - A Predefined Substudy of the Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial. Critical Care Medicine. 2025 Apr 1;53(4):e916-e927. 6619. Epub 2025 Feb 24. doi: 10.1097/CCM.0000000000006619