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Original research article
Associations between common ECG abnormalities and out-of-hospital cardiac arrest
  1. Marc Meller Søndergaard1,
  2. Jonas Bille Nielsen2,3,
  3. Rikke Nørmark Mortensen1,
  4. Gunnar Gislason4,5,
  5. Lars Køber6,
  6. Freddy Lippert7,
  7. Claus Graff8,
  8. Stig Haunsø6,9,
  9. Jesper Hastrup Svendsen10,11,
  10. Kristian Hay Kragholm1,12,
  11. Adrian Holger Pietersen13,
  12. Bent Struer Lind14,
  13. Søren Pihlkjær Hjortshøj15,
  14. Anders Gaarsdal Holst11,
  15. Johannes Jan Struijk8,
  16. Christian Torp-Pedersen1,8 and
  17. Steen Møller Hansen1
  1. 1Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark
  2. 2Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
  4. 4Department of Cardiology, Herlev Hospital, Herlev, Denmark
  5. 5National Institute of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
  6. 6Department of Cardiology, Rigshospitalet, Kobenhavn, Denmark
  7. 7Emergency Medical Services Copenhagen, University of Copenhagen, Kobenhavns, Denmark
  8. 8Department of Health, Science and Technology, Aalborg Universitet Det Sundhedsvidenskabelige Fakultet, Aalborg, Denmark
  9. 9Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark
  10. 10Department of Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark
  11. 11Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark
  12. 12Department of Cardiology, Regionshospital Nordjylland, Hjorring, Nordjylland, Denmark
  13. 13Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerod, Denmark
  14. 14Department of Clinical Biochemistry, Hvidovre Hospital, Hvidovre, Denmark
  15. 15Department of Cardiology, Aalborg Universitetshospital, Aalborg, Denmark
  1. Correspondence to Marc Meller Søndergaard; marc-m-s12{at}


Background Out-of-hospital cardiac arrest (OHCA) is often the first manifestation of unrecognised cardiac disease. ECG abnormalities encountered in primary care settings may be warning signs of OHCA.

Objective We examined the association between common ECG abnormalities and OHCA in a primary care setting.

Methods We cross-linked individuals who had an ECG recording between 2001 and 2011 in a primary care setting with the Danish Cardiac Arrest Registry and identified OHCAs of presumed cardiac cause.

Results A total of 326 227 individuals were included and 2667 (0,8%) suffered an OHCA. In Cox regression analyses, adjusted for age and sex, the following ECG findings were strongly associated with OHCA: ST-depression without concomitant atrial fibrillation (HR 2.79; 95% CI 2.45 to 3.18), left bundle branch block (LBBB; HR 3.44; 95% CI 2.85 to 4.14) and non-specific intraventricular block (NSIB; HR 3.15; 95% CI 2.58 to 3.83). Also associated with OHCA were atrial fibrillation (HR 1.89; 95% CI 1.63 to 2.18), Q-wave (HR 1.75; 95% CI 1.57 to 1.95), Cornell and Sokolow-Lyon criteria for left ventricular hypertrophy (HR 1.56; 95% CI 1.33 to 1.82 and HR 1.27; 95% CI 1.12 to 1.45, respectively), ST-elevation (HR 1.40; 95% CI 1.09 to 1.54) and right bundle branch block (HR 1.29; 95% CI 1.09 to 1.54). The association between ST-depression and OHCA diminished with concomitant atrial fibrillation (HR 1.79; 95% CI 1.42 to 2.24, p < 0.01 for interaction). Among patients suffering from OHCA, without a known cardiac disease at the time of the cardiac arrest, 14.2 % had LBBB, NSIB or ST-depression.

Conclusions Several common ECG findings obtained from a primary care setting are associated with OHCA.

  • ECG
  • out-of-hospital cardiac arrest
  • cardiac disease
  • risk

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  • Contributors A table with the individual contributions of the different authors can be found in the manuscript, page 21, line 414-415.

  • Funding The Danish foundation TrygFonden provided economic support for the Danish Cardiac Arrest Registry. The Danish foundation TrygFonden had no role in the data collection, study design, data analysis or interpretation of the data. Furthermore, they had no role in preparation, review or approval of this manuscript.

  • Competing interests SMH is supported by an unrestricted grant from The Danish foundation TrygFonden and the Danish Heart Foundation. KK reports having received grants from the Danish Heart Foundation, The Fund of Herta Christensen and the Laerdal Foundation. FKL reports having an unrestricted research grants from The Danish foundation TrygFonden and the Laerdal Foundation. CT-P reported serving as a consultant for Cardiome, Merck, Sanofi, Daiichi, and Bristol-Myers Squibb and receiving grants or grants pending from Bristol-Myers Squibb. Dr Holst is an employee of Novo Nordisk. JHS reported serving as a consultant for Medtronic, receiving speaker fee from Medtronic, JHS also reported receiving research grants from Medtronic and Gilead. LK reports personal fees from Novartis and Sanofi.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Danish Data Protection Agency ( 2008-58-0028, internal reference RN-2016-3). Ethical approval is not required for retrospective registry-based studies in Denmark.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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