Wednesday, November 30, 2011

Can the post resuscitation electrocardiogram distinguish between patients who do or do not need to go to the cath lab post resuscitation?

According to this paper it can help despite recent teaching which says it is unreliable:

ST-segment elevation predicted AMI with 88% sensitivity and 84% specificity. The criterion including ST-segment elevation and/or depression had 95% sensitivity and 62% specificity. The combined criterion including ST-segment elevation and/or depression, and/or non-specific wide QRS complex and/or left bundle branch block provided a sensitivity and negative predictive value of 100%, a specificity of 46% and a positive predictive value of 52%.

So reliance on classic STEMI criteria is not enough because it will miss at least 22% of patients who need to go to the lab. On the other hand the use of combined criteria (meaning the patient's EKG has to be nearly stone-cold normal to avoid a trip to the lab) has very high sensitivity.