Cardiac arrest & resuscitation
The post-ROSC ECG: morphological spectrum of non-ST-elevation occlusion and prognostic markers after cardiac arrest
Authors' conclusion
On the first post-ROSC ECG, angiographically confirmed occlusion concentrated around a small number of NST-OMI morphologies - findings of crucial importance for identification and appropriate management. PR-segment prolongation predicted reduced 30-day survival - indicating prognostic information beyond ischaemia detection.
Study context
- Population
- Cardiac arrest survivors admitted to a tertiary ICU (2020–2025), first post-ROSC ECG; Coronary angiography (CAG) as reference standard for occlusive myocardial infarction (OMI)101 CAG-confirmed OMI
- Participants
- 214 survivors
- Exposure
- NST-OMI vs STEMI patterns on first post-ROSC ECG; ECG features in non-survivors vs survivors
- Outcome
- Distribution of NST-OMI patterns post-ROSC; association of quantitative ECG features with survival
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
NST-OMI patterns among CAG-confirmed OMI
- Left-main equivalent
- 8%
- Smith-modified Sgarbossa criteria
- 8%
- Aslanger pattern
- 5%
- Lateral OMI
- 4%
- Shark-fin sign
- 4%
- Hyperacute t-wave
- 4%
Observational data: associations, not effects.
Further findings
Prevalence of pattern, overall
Prevalence of pattern among CAG-confirmed OMI
Underwent CAG
P = 0.002
PR-segment prolongation and 30-day survival (multivariable)
| aOR (CI) | P value | ||
|---|---|---|---|
| PR-segment prolongationIndependently associated with reduced 30-day survival | 0.977 (0.956–0.998) | P = 0.032 | |
| 0.512Adjusted odds ratio (log scale) |
| Outcome | P value |
|---|---|
| PR-segment, non-survivors vs survivors | P = 0.008 |
| QRS-duration, non-survivors vs survivors | P = 0.003 |
| P-wave duration, non-survivors vs survivors | P = 0.027 |
- PR-segment, non-survivors vs survivors: Non-survivors 74 ms
- PR-segment, non-survivors vs survivors: Survivors 57 ms
- QRS-duration, non-survivors vs survivors: Non-survivors 130 ms
- QRS-duration, non-survivors vs survivors: Survivors 108 ms
- P-wave duration, non-survivors vs survivors: Non-survivors 105 ms
- P-wave duration, non-survivors vs survivors: Survivors 108 ms
Mortality, NST-OMI without CAG · 30 days
- Highest 30-day mortality among NST-OMI patients not undergoing CAG
- 75%
- p = 0.005
Original publication
The post-ROSC ECG: morphological spectrum of non-ST-elevation occlusion and prognostic markers after cardiac arrest. Resuscitation. Published 25 September 2026. doi:10.
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