A woman in her 60s with VFib arrest and no STEMI on her post-ROSC ECG.

This study had a fatal flaw: they did not keep track of all the " Non-STEMI patients " who were NOT enrolled, but instead were sent for immediate angiogram.  It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab.  So it is highly likely that physicians were very reluctant to enroll patients whom they suspected had Occlusion MI (OMI), even if they didnot have STEMI. These physicians did not want a patient with an OMI that was not a STEMI to be randomized to no angiogram.  This strong suspicion is supported by their data: only 22 of 437 (5.0%) patients in this study had OMI.What percent of shockable arrests without STE have an OMI?  This large registry in Circulation 2010 reported that at least 1 significant coronary artery lesion was found in 128 (96%) of 134 patients with ST-segment elevation on the ECG performed after the return of spontaneous circulation, and in 176 (58%) of 301 patients without ST-segment elevation. 5% vs. 58%!!  It is clear that there was signficant enrollment bias in COACT.We at Hennepin recently published this studySharma et al. (with Smith and others) found that among patients with shockable cardiac arrest who had OMI, the initialand subsequent pre-angiogram ECG were only 75% sensitive for OMI, with similar specificity.Sharma A, Miranda DF, Rodin H, Bart BA, Smith SW, Shroff GR.Do not disregard the initial 12 lead ECG after o...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs