PDF(Pubmed)
Abstract：
BACKGROUND: In patients resuscitated from cardiac arrest and displaying no ST-segment elevation on initial electrocardiogram (ECG), recent randomized trials indicated no benefits from early coronary angiography. How the results of such randomized studies apply to a real-world clinical context remains to be established.
METHODS: We retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses.
RESULTS: We analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients.
CONCLUSIONS: Our results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation.
METHODS: We retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses.
RESULTS: We analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients.
CONCLUSIONS: Our results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation.
摘要：
背景：在心脏骤停复苏并在初始心电图（ECG）上显示无ST段抬高的患者中，最近的随机试验表明,早期冠状动脉造影没有获益.这些随机研究的结果如何适用于现实世界的临床背景仍有待确定。
方法：我们回顾性分析了一个临床数据库，该数据库包括2017年1月至2020年8月在三级大学医院成功复苏后收治的所有18岁或18岁以上的患者。并立即进行冠状动脉造影，无论初始心律和复苏后心电图。该研究的主要结果是心脏骤停后第90天的生存率。人口统计数据,心脏骤停的特点，复苏的持续时间，入院时的实验室值，收集血管造影数据和血运重建情况.根据初始心电图（ST段抬高与否）进行比较，在幸存者和非幸存者之间。通过单变量和多变量回归分析评估与主要结果相关的变量。
结果：我们分析了147例患者（130例OHCA和17例IHCA），包括67与STEMI和80无STEMI（无STEMI）。在65/67（97％）STEMI和15/80（19％）无STEMI中进行立即血运重建。STEMI的第90天生存率（48/67，72％）明显高于无STEMI（44/80，55％）。在后一种患者中，生存率不受血运重建状态的影响.在单变量和多变量分析中，年龄较低,令人震惊的节奏，无流量和低流量的持续时间较短，较低的初始血乳酸与STEMI和无STEMI患者的生存率相关。相比之下,代谢异常，仅在无STEMI患者亚组,包括较低的初始血浆钠和较高的钾与死亡率显著相关.
结论：我们的结果，在现实世界的临床环境中获得，提示在最初的心电图上没有ST段抬高的情况下,因推测的心脏原因而从心脏骤停中复苏的患者,立即进行冠状动脉造影与任何生存优势无关。此外，我们发现，一些早期代谢异常可能与该人群的死亡率有关，这应该值得进一步调查。
方法：我们回顾性分析了一个临床数据库，该数据库包括2017年1月至2020年8月在三级大学医院成功复苏后收治的所有18岁或18岁以上的患者。并立即进行冠状动脉造影，无论初始心律和复苏后心电图。该研究的主要结果是心脏骤停后第90天的生存率。人口统计数据,心脏骤停的特点，复苏的持续时间，入院时的实验室值，收集血管造影数据和血运重建情况.根据初始心电图（ST段抬高与否）进行比较，在幸存者和非幸存者之间。通过单变量和多变量回归分析评估与主要结果相关的变量。
结果：我们分析了147例患者（130例OHCA和17例IHCA），包括67与STEMI和80无STEMI（无STEMI）。在65/67（97％）STEMI和15/80（19％）无STEMI中进行立即血运重建。STEMI的第90天生存率（48/67，72％）明显高于无STEMI（44/80，55％）。在后一种患者中，生存率不受血运重建状态的影响.在单变量和多变量分析中，年龄较低,令人震惊的节奏，无流量和低流量的持续时间较短，较低的初始血乳酸与STEMI和无STEMI患者的生存率相关。相比之下,代谢异常，仅在无STEMI患者亚组,包括较低的初始血浆钠和较高的钾与死亡率显著相关.
结论：我们的结果，在现实世界的临床环境中获得，提示在最初的心电图上没有ST段抬高的情况下,因推测的心脏原因而从心脏骤停中复苏的患者,立即进行冠状动脉造影与任何生存优势无关。此外，我们发现，一些早期代谢异常可能与该人群的死亡率有关，这应该值得进一步调查。
