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Early prediction of ventricular fibrillation using electrocardiographic characteristics in prehospital suspected ST-segment elevation myocardial infarction: a case–control study

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Abstract

Purpose

Our objective was to determine characteristics of electrocardiograms (ECG) that predict ventricular fibrillation (VF) among prehospital patients with suspected ST-segment elevation myocardial infarction (STEMI) in Québec.

Methods

We performed a matched case–control study of prehospital adult suspected with STEMI. Patients in case group (STEMI/VF+) were matched with controls (STEMI/VF–) for age and sex and then compared for ECG characteristics, including ST-segment elevations (STE) and depressions (STD), duration of interval complexes, general characteristics, and several calculated variables. Logistic regression was used to measure the association between ECG characteristics and VF development.

Results

Overall, 310 prehospital patients with suspected STEMI were included in the analysis (case group, n = 155; control group, n = 155). We confirmed that the presence of TW-pattern complex (OR 7.0, 95% CI 1.55–31.58), premature ventricular contraction (PVC) (OR 5.5, 95% CI 2.04–14.82), and STE in V2–V6 (OR 3.8, 95% CI 1.21–11.74) were electrocardiographic predictors of VF. We also observed that STD in V3–V5 (OR 6.5, 95% CI 1.42–29.39), atrial fibrillation (AF) ≥ 100 beats per minute (bpm) (OR 6.3, 95% CI 1.80–21.90), the combination of STE in V4 and V5, and STD in II, III and aVF (OR 4.8, 95% CI 1.01–22.35), and the presence of STD in ≥ 6 leads (OR 4.2, 95% CI 1.33–13.13) were also associated with VF development. Finally, simultaneous association of 2 (OR 2.3, 95% CI 1.13–4.06) and 3 (OR 11.6, 95% CI 3.22–41.66) predictors showed significant association with VF.

Conclusions

In addition to some already known predictors, we have identified several ECG findings associated with the development of VF in patients with suspected STEMI. Early identification of patients with STEMI at increased risk of VF should help EMS providers anticipate adverse events and encourage use of defibrillation pads.

Résumé

Objectif

Notre objectif était de déterminer les caractéristiques des électrocardiogrammes (ECG) qui prédisent la fibrillation ventriculaire (FV) chez les patients préhospitaliers suspectés d’infarctus du myocarde à élévation du segment ST (STEMI) au Québec.

Méthodes

Nous avons effectué une étude cas-témoin appariée de l’adulte préhospitalier suspecté avec STEMI. Les patients du groupe de cas (STEMI/VF+) ont été appariés avec les témoins (STEMI/VF-) pour l’âge et le sexe, puis comparés pour les caractéristiques ECG, y compris les élévations du segment ST (STE) et les dépressions (STD), la durée des complexes d’intervalles, les caractéristiques générales et plusieurs variables calculées. La régression logistique a été utilisée pour mesurer l’association entre les caractéristiques de l’ECG et le développement de la FV.

Résultats

Dans l’ensemble, 310 patients préhospitaliers présentant un STEMI suspecté ont été inclus dans l’analyse (groupe de cas, n = 155; groupe témoin, n = 155). Nous avons confirmé que la présence de complexes TW (OR 7,0, IC à 95% 1,55–31,58), de contraction ventriculaire prématurée (PVC) (OR 5,5, IC à 95% 2,04–14,82) et de STE dans V2–V6 (OR 3,8, IC à 95% 1,21–11,74) étaient des prédicteurs électrocardiographiques de la FV. Nous avons également observé que STD dans V3-V5 (OR 6,5, IC à 95% 1,42–29,39), fibrillation auriculaire (AF) 100 battements par minute (bpm) (OR 6,3, IC à 95% 1,80–21,90), la combinaison de STE dans V4 et V5, et STD dans II, III et aVF (OR 4,8, IC à 95% 1,01–22,35) et la présence de STD dans 6 dérivations (OR 4.2, IC à 95% 1.33–13.13) ont également été associés au développement de la FV. Enfin, l’association simultanée de 2 (OR 2,3, IC à 95% 1,13–4,06) et 3 (OR 11,6, IC à 95% 3,22–41,66) prédicteurs a montré une association significative avec la FV.

Conclusions

En plus de certains prédicteurs déjà connus, nous avons identifié plusieurs résultats d’ECG associés au développement de la FV chez des patients présentant une STEMI suspectée. L’identification précoce des patients atteints de STEMI à risque accru de FV devrait aider les fournisseurs de soins médicaux d’urgence à anticiper les événements indésirables et à encourager l’utilisation de tampons de défibrillation.

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Data availability

The datasets generated during and/or analysed during the current study are available from corresponding author on reasonable request.

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Acknowledgements

The authors sincerely thank all members of the UCCSPU, the CISSS Chaudière-Appalaches and of Urgences-santé who assisted the research team in accessing records and data, as well as Percipient Research & Consulting for providing assistance with language editing.

Funding

This work was supported by the Fondation Hôtel-Dieu de Lévis, Lévis, Québec, Canada. The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Unité de Coordination Clinique des Services Préhospitaliers d’Urgence (UCCSPU), Lévis, QC, Canada

    Alain Tanguay, Johann Lebon & Denise Hébert

  2. Centre de Recherche du CISSS Chaudières-Appalaches, Lévis, QC, Canada

    Alain Tanguay & Johann Lebon

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  1. Alain Tanguay
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All authors have participated in the work and have reviewed and agree with the content of the article. AT is the guarantor of this work. He had full access to all of the data and takes full responsibility for the integrity of the data and the accuracy of the analyses. AT and JL performed the literature review, prepared and wrote the manuscript, and contributed to the discussion. JL collected and analyzed the data. DH and AT participated in data collection, reviewed the manuscript, and approved of the final version submitted.

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Correspondence to Johann Lebon.

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Tanguay, A., Lebon, J. & Hébert, D. Early prediction of ventricular fibrillation using electrocardiographic characteristics in prehospital suspected ST-segment elevation myocardial infarction: a case–control study. Can J Emerg Med 25, 728–735 (2023). https://doi.org/10.1007/s43678-023-00565-4

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