Merchant Raina M, Abella Benjamin S, Khan Monica, Huang Kuang-Ning, Beiser David G, Neumar Robert W, Carr Brendan G, Becker Lance B, Vanden Hoek Terry L
The Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, United States.
Resuscitation. 2008 Dec;79(3):398-403. doi: 10.1016/j.resuscitation.2008.07.015. Epub 2008 Oct 31.
Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival.
Using a billing database we retrospectively identified cases with an ICD-9 code of cardiac arrest (427.5) or VF (427.41). Discharge summaries were reviewed to identify in-hospital VF arrests. Rates of catheterization on the day of arrest were determined by identifying billing charges. Unadjusted analyses were performed using Chi-square, and adjusted analyses were performed using logistic regression.
One hundred and ten in-hospital VF arrest survivors were included in the analysis. Cardiac catheterization was performed immediately or within 1 day of arrest in 27% (30/110) of patients and of these patients, 57% (17/30) successfully received percutaneous coronary intervention. Of those who received cardiac catheterization the indication for the procedure was STEMI or new left bundle branch block (LBBB) in 43% (13/30). Therefore, in the absence of standard ECG data suggesting acute myocardial infarction, 57% (17/30) received angiography. Patients receiving cardiac catheterization were more likely to survive than those who did not receive catheterization (80% vs. 54%, p<.05).
In patients receiving cardiac catheterization, more than half received this procedure for indications other than STEMI or new LBBB. Cardiac catheterization was associated with improved survival. Future recommendations need to be established to guide clinicians on which arrest survivors might benefit from immediate catheterization.
对于非ST段抬高型心肌梗死（STEMI）的心脏骤停幸存者，立即进行心脏导管插入术的指征尚不确定，因为心电图和临床标准在这一人群中可能难以解读。我们试图评估院内心室颤动（VF）骤停后早期导管插入术的发生率及其与生存率的关联。
利用计费数据库，我们回顾性地确定了国际疾病分类第九版（ICD - 9）编码为心脏骤停（427.5）或VF（427.41）的病例。审查出院小结以确定院内心室颤动骤停情况。通过识别计费费用来确定骤停当天的导管插入术发生率。使用卡方检验进行未调整分析，使用逻辑回归进行调整分析。
110例院内心室颤动骤停幸存者纳入分析。27%（30/110）的患者在骤停后立即或1天内接受了心脏导管插入术，其中57%（17/30）成功接受了经皮冠状动脉介入治疗。在接受心脏导管插入术的患者中，43%（13/30）的手术指征为STEMI或新发左束支传导阻滞（LBBB）。因此，在没有提示急性心肌梗死的标准心电图数据的情况下，57%（17/30）的患者接受了血管造影。接受心脏导管插入术的患者比未接受导管插入术的患者更有可能存活（80%对54%，p<0.05）。
在接受心脏导管插入术的患者中，超过一半接受该手术的指征并非STEMI或新发LBBB。心脏导管插入术与生存率提高相关。需要制定未来的建议，以指导临床医生哪些骤停幸存者可能从立即进行导管插入术中获益。
