Written by Colin O’Shea
Spoon Feed
In this study of patients with out-of-hospital cardiac arrest (OHCA), STEMI criteria predicted 47% of cases of occlusive myocardial infarction, but STEMI plus other high-risk features predicted 92%.
STEMI criteria alone fall short again…
This was a retrospective study of patients at a single ICU who suffered OHCA and had return of spontaneous circulation (ROSC). The study split patients into two groups based on their first post-resuscitation ECG; those whose ECG met STEMI criteria and those who did not but had other high-risk ECG features (as discussed in this previous JournalFeed post). Cardiac angiography (CAG) results and rates of occlusion myocardial infarction (OMI) were compared as well.
Among 97 patients enrolled in the study, 32% of post-ROSC ECGs met STEMI criteria and 30% had high-risk features. Compared to patients with high-risk features on ECG, those meeting STEMI criteria on ECG were younger (61 years vs. 71 years; p=0.002) and went to the cath lab faster (47.5 vs 101.5 minutes; p=0.004). Comparing patients with STEMI ECG and those with high-risk ECG, rates of OMI were similar (81% vs 86%; p=0.868). Patients with high-risk ECG were more likely to have a higher burden of multivessel disease on CAG. The authors theorize that electrical vectors from multiple ischemic zones may result in less ST elevation.
The big take-home point is, STEMI criteria predicted 47% of cases of OMI, but STEMI plus high-risk criteria predicted 92% of cases of OMI.
Limitations of this study include its small sample size, retrospective nature, and potential selection bias. However, this paper underscores the importance of understanding other high-risk features on ECG.
How will this change my practice?
This paper is in keeping with the others we have covered this week, emphasizing the limitations of strict STEMI criteria in predicting occlusive disease. In addition to looking for STEMI criteria on ECG, check for other high-risk features to guide cath lab activation, rather than an over-simplified STEMI vs. no-STEMI approach.
Source
Beyond STEMI: High-risk ECG patterns as predictors of occlusive myocardial infarction in out-of-hospital cardiac arrest patients. Resuscitation. 2025 Aug 7;215:110763. doi: 10.1016/j.resuscitation.2025.110763. Epub ahead of print. PMID: 40783097.
