Prevalence of STEMI Presentation Post-ROSC
The prevalence of STEMI presentation after return of spontaneous circulation (ROSC) ranges from approximately 5.7% to 7.2% of all cardiac arrest survivors, though among those with suspected cardiac etiology and no obvious non-cardiac cause, the rate of acute coronary lesions is substantially higher at 59-71%. 1
Epidemiological Data
Overall STEMI Prevalence in Cardiac Arrest Survivors
- In unselected cardiac arrest populations, STEMI accounts for 5.7-7.2% of all ROSC cases. 2, 3
- Among 2,393 consecutive STEMI patients, 135 (5.7%) presented after achieving ROSC, with 36% regaining consciousness and 64% remaining comatose during initial evaluation. 2
- In another cohort of 1,836 consecutive STEMI admissions for primary PCI, 132 patients (7.2%) had suffered out-of-hospital cardiac arrest with ROSC. 3
STEMI in Cardiac Arrest of Suspected Cardiac Origin
- When focusing specifically on out-of-hospital cardiac arrest patients without obvious non-cardiac etiology, the prevalence of acute coronary artery lesions is dramatically higher at 59-71%. 1
- Among patients with ST-segment elevation or left bundle branch block on post-ROSC ECG, more than 80% will have an acute coronary lesion requiring intervention. 1
Diagnostic Accuracy Considerations
ECG Findings Post-ROSC
- In comatose cardiac arrest survivors, ST-segment elevations were present in 54% of post-ROSC ECGs, but only 48% ultimately had confirmed STEMI. 4
- The sensitivity of ST-elevation on ROSC-ECG for predicting STEMI is 74% (95% CI 62-84%), with specificity of 65% (95% CI 53-75%). 4
- Timing of ECG acquisition matters significantly: ECGs obtained ≤7 minutes after ROSC have an 18.5% false-positive rate for STEMI compared to 7.2% at 8-33 minutes and 5.8% beyond 33 minutes. 5
Distribution by Consciousness Status
- Among STEMI patients post-ROSC, approximately one-third (30-36%) present with normal neurologic status or regain consciousness, while two-thirds (64-70%) remain comatose. 1, 2
- Conscious patients with STEMI after cardiac arrest have survival rates comparable to STEMI patients without cardiac arrest (94.8-100% hospital survival without neurological deficit). 2
Clinical Context for Prevalence Interpretation
Non-Shockable Rhythms
- In patients with non-shockable initial rhythms (PEA/Asystole) who achieve ROSC and do not have STEMI on ECG, the overall incidence of coronary intervention is 5.5%, though among those selected for angiography without STEMI indication, 24.7% still required coronary intervention. 6
Prognostic Implications
- The presence of STEMI post-ROSC carries different prognostic implications based on neurologic status: conscious patients have excellent outcomes with primary PCI, while comatose patients have 51% hospital survival overall and only 29% survival with good neurologic outcome (CPC 1-2). 2
- Time to ROSC is a critical determinant: every additional minute increases mortality hazard by 1.7% and increases odds of neurological deficit by 7.0%. 3
Common pitfall: Do not assume all ST-elevations immediately post-ROSC represent true STEMI—early ECGs (≤7 minutes) have nearly triple the false-positive rate compared to those obtained after 8 minutes, so consider repeating the ECG if obtained very early or if clinical picture is discordant. 5