Acute cardiac care & 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 ECG101 had coronary angiography (CAG)-confirmed occlusive myocardial infarction (OMI)
- Participants
- 214 survivors
- Exposure
- NST-OMI patterns vs STEMI
Main finding
As reported in the abstract
Distribution of 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 NST-OMI vs STEMI patterns
Overall
Among CAG-confirmed OMI cases
Underwent CAG
30-day survival by PR-segment prolongation
| Comparison | aOR (CI) | P value | |
|---|---|---|---|
| PR-segment prolongation · after multivariable adjustment; reduced 30-day survival · multivariable adjustment | 0.977 (0.956–0.998) | P = 0.032 | |
| 0.512Adjusted odds ratio (log scale) |
- Prevalence of NST-OMI vs STEMI patterns: CAG: p = 0.002
- ECG features, non-survivors vs survivors: non-survivors PR-segment 74 · QRS-duration 130 · P-wave duration 105
- ECG features, non-survivors vs survivors: survivors PR-segment 57 · QRS-duration 108 · P-wave duration 108
- ECG features, non-survivors vs survivors: PR-segment p = 0.008
- ECG features, non-survivors vs survivors: QRS-duration p = 0.003
- ECG features, non-survivors vs survivors: P-wave duration p = 0.027
30-day mortality among NST-OMI patients not undergoing CAG
- Highest 30-day mortality, 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.
Summarised from the published abstract; every number is checked against it