Associazione Nazionale Medici Cardiologi Ospedalieri



Post-ROsc ecG pREdictS Survival after out-of hospital cardiac arrest. The PROGRESS score

Lopiano Clara Pavia(Pavia) – IRCCS Policlinico San Matteo | Pontremoli Silvia Miette Pavia(Pavia) – IRCCS Policlinico San Matteo | Bendotti Sara Pavia(Pavia) – IRCCS Policlinico San Matteo


Prognostic assessment of patients following out-of-hospital cardiac arrest (OHCA) is critical to guide care after return of spontaneous circulation (ROSC). The ECG acquired after ROSC in patients with OHCA has proven to be crucial not only for its diagnostic role but also for its prognostic purposes. Indeed, certain electrocardiographic features have been shown to be directly correlated with an increased risk of mortality. We developed a score (PROGRESS-SCORE) that can predict 30-day mortality risk in post-OHCA patients, identifying three risk classes: low (0-4), intermediate (5-7) and high (8-26). The current aim is to validate PROGRESS-SCORE in a new cohort of patients.


We retrospectively applied the PROGRESS score to prospectively collected data. Post-ROSC ECGs of patients enrolled from 1/1/2015 to 31/12/2022 from the Lombardy Cardiac Arrest Registry (LombardiaCARe) were collected. Predictors considered were: age >62 years, female sex, presence of more than 1 segment with ST elevation, QRS >120 ms, and diagnostic pattern for Brugada Syndrome. Three risk groups were identified according to the previous classification: low (0-4), intermediate (5-7) and high (8-26). Calibration was assessed by plotting the observed proportions of events against the predicted probabilities: the Harrel-c, derived from a univariable Cox regression, was assessed for discrimination, taking into account the risk category as the independent variable.


A total of 792 post-ROSC ECGs were collected: 490 males (61.9%) with a median age of 70 years; median ECG acquisition time from ROSC was 7 minutes (4.2 – 21.0). 348 (43.9%) patients survived to 30 days and 335 (42.3%) died. Mortality was similar between the intermediate-risk and low-risk groups (HR:1.2[95%CI,0.8-1.9]; p:0.35), but higher in the high-risk group than in the low-risk group (HR:1.9[95%CI,1.3-2.8];p:0.001).


Our results show that post-ROSC ECG can discriminate patients at high risk of mortality after OHCA. This provides a possibility for risk stratification in post-ROSC care, which is essential in order to guide resource allocation. Consequently, the application of our score would help personalization of care.