Abstract：
BACKGROUND: The incidence of sudden cardiac arrest (SCA) during acute coronary syndrome is somewhat unclear, since often subjects dying before the first healthcare contact are not included in the estimates. We aimed to investigate the complete incidence of SCA during ACS.
METHODS: The study population consists of two cohorts. The first cohort includes 472 ACS patients from Northern Ostrobothnia, Finland from year 2016 and the second cohort 162 autopsy-verified SCD subjects (extrapolated) from the same region and year, whose death was attributable to coronary artery disease (CAD) and ACS. An extrapolation of SCA incidence during ACS was done by utilizing autopsy data and data from prior autopsy study on this sample.
RESULTS: The overall incidence of SCA in the setting of ACS was 17.5%. The incidence of SCA was 20.6% in all ACS subjects without prior CAD diagnosis, and 25.4% in STEMI subjects without prior CAD diagnosis. In subjects with previously diagnosed CAD, the incidence of SCA was 10.9% in all ACS subjects and 16.1% in STEMI subjects. There was a statistically significant difference in the incidence of SCA between subjects with and without prior CAD diagnoses (p=0.0052).
CONCLUSIONS: The inclusion of ACS-SCA subjects dying before the first emergency medical service (EMS) contact results in a higher and likely more accurate estimation of SCA during ACS. The incidence of SCA was higher among subjects without prior CAD diagnosis. The high mortality rate highlights the importance of early ACS detection to reduce the burden of CAD-related premature deaths.
METHODS: The study population consists of two cohorts. The first cohort includes 472 ACS patients from Northern Ostrobothnia, Finland from year 2016 and the second cohort 162 autopsy-verified SCD subjects (extrapolated) from the same region and year, whose death was attributable to coronary artery disease (CAD) and ACS. An extrapolation of SCA incidence during ACS was done by utilizing autopsy data and data from prior autopsy study on this sample.
RESULTS: The overall incidence of SCA in the setting of ACS was 17.5%. The incidence of SCA was 20.6% in all ACS subjects without prior CAD diagnosis, and 25.4% in STEMI subjects without prior CAD diagnosis. In subjects with previously diagnosed CAD, the incidence of SCA was 10.9% in all ACS subjects and 16.1% in STEMI subjects. There was a statistically significant difference in the incidence of SCA between subjects with and without prior CAD diagnoses (p=0.0052).
CONCLUSIONS: The inclusion of ACS-SCA subjects dying before the first emergency medical service (EMS) contact results in a higher and likely more accurate estimation of SCA during ACS. The incidence of SCA was higher among subjects without prior CAD diagnosis. The high mortality rate highlights the importance of early ACS detection to reduce the burden of CAD-related premature deaths.
摘要：
背景：急性冠状动脉综合征期间心脏骤停（SCA）的发生率尚不清楚，因为通常在第一次医疗保健接触之前死亡的受试者不包括在估计中。我们旨在调查ACS期间SCA的完全发生率。
方法：研究人群由两个队列组成。第一个队列包括472名来自北Ostrobothnia的ACS患者，芬兰2016年和第二队列162尸检验证SCD受试者（外推）来自同一地区和年份，其死亡可归因于冠状动脉疾病（CAD）和ACS。通过利用尸检数据和先前对该样本进行尸检研究的数据，对ACS期间的SCA发生率进行了推断。
结果：在ACS患者中，SCA的总发生率为17.5%。SCA的发生率为20.6%，在所有没有CAD诊断的ACS患者中，在没有事先诊断CAD的STEMI受试者中，为25.4%。在先前诊断为CAD的受试者中，所有ACS受试者的SCA发生率为10.9%,STEMI受试者为16.1%.在有和没有先前CAD诊断的受试者之间，SCA的发生率存在统计学上的显着差异（p=0.0052）。
结论：纳入ACS-SCA受试者在首次急诊医疗服务（EMS）接触前死亡，可导致ACS期间对SCA的估计更高，可能更准确。在没有事先诊断CAD的受试者中，SCA的发生率更高。高死亡率凸显了早期ACS检测对减轻CAD相关过早死亡负担的重要性。
方法：研究人群由两个队列组成。第一个队列包括472名来自北Ostrobothnia的ACS患者，芬兰2016年和第二队列162尸检验证SCD受试者（外推）来自同一地区和年份，其死亡可归因于冠状动脉疾病（CAD）和ACS。通过利用尸检数据和先前对该样本进行尸检研究的数据，对ACS期间的SCA发生率进行了推断。
结果：在ACS患者中，SCA的总发生率为17.5%。SCA的发生率为20.6%，在所有没有CAD诊断的ACS患者中，在没有事先诊断CAD的STEMI受试者中，为25.4%。在先前诊断为CAD的受试者中，所有ACS受试者的SCA发生率为10.9%,STEMI受试者为16.1%.在有和没有先前CAD诊断的受试者之间，SCA的发生率存在统计学上的显着差异（p=0.0052）。
结论：纳入ACS-SCA受试者在首次急诊医疗服务（EMS）接触前死亡，可导致ACS期间对SCA的估计更高，可能更准确。在没有事先诊断CAD的受试者中，SCA的发生率更高。高死亡率凸显了早期ACS检测对减轻CAD相关过早死亡负担的重要性。
