急性ST段抬高型心肌梗死合并心脏骤停的急诊经皮冠状动脉介入治疗的结果

Outcome of emergency percutaneous coronary intervention for acute ST-elevation myocardial infarction complicated by cardiac arrest.

作者信息

Mager Aviv, Kornowski Ran, Murninkas Daniel, Vaknin-Assa Hana, Ukabi Shimrit, Brosh David, Battler Alexander, Assali Abid

机构信息

Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.

出版信息

Coron Artery Dis. 2008 Dec;19(8):615-8. doi: 10.1097/MCA.0b013e32831381b4.

DOI:10.1097/MCA.0b013e32831381b4

PMID:19005296

Abstract

BACKGROUND

The poor prognosis of primary percutaneous coronary intervention (PCI) in patients resuscitated from cardiac arrest complicating acute ST-segment elevation myocardial infarction (STEMI) may at least partly be explained by the common presence of cardiogenic shock. This study examined the impact of emergency primary PCI on outcome in patients with STEMI not complicated by cardiogenic shock who were resuscitated from cardiac arrest.

METHODS AND RESULTS

The study group included 948 consecutive patients without cardiogenic shock who underwent emergency primary PCI from 2001 to 2006 for STEMI. Twenty-one of them were resuscitated from cardiac arrest before the intervention. Data on background, clinical characteristics, and outcome were prospectively collected. There were no differences between the resuscitated and nonresuscitated patients in age, sex, infarct location, or left ventricular function. The total one-month mortality rate was higher in the resuscitated patients (14.3 vs. 3.4%, P=0.033), but noncardiac mortality accounted for the entire difference (14.3 vs. 1.2%, P=0.001), whereas cardiac mortality was similarly low in the two groups (0 vs. 2.0%, P=NS). Predictors of poor outcome in the resuscitated patients were older age (r=0.47, P=0.032), unwitnessed sudden death (r=0.44, P=0.04), longer interval between onset of cardiac arrest and arrival of a mobile unit (r=0.67, P=0.001) or to spontaneous circulation (r=0.65, P=0.001), low glomerular filtration rate (r=-0.50, P=0.02), and the initial thrombolysis in myocardial infarction grade of flow (r=-0.51, P=0.017).

CONCLUSION

Emergency PCI for STEMI not associated with cardiogenic shock exerts a similar effect on cardiac mortality in patients who were resuscitated from cardiac arrest and in those without this complication. The higher all-cause mortality rate among resuscitated patients is explained by noncardiac complications.

摘要

背景

在因急性ST段抬高型心肌梗死（STEMI）并发心脏骤停而复苏的患者中，急诊经皮冠状动脉介入治疗（PCI）的预后较差，这至少部分可以由心源性休克的普遍存在来解释。本研究探讨了急诊PCI对从心脏骤停中复苏且无并发心源性休克的STEMI患者预后的影响。

方法与结果

研究组包括948例在2001年至2006年期间因STEMI接受急诊PCI且无心脏性休克的连续患者。其中21例在介入治疗前从心脏骤停中复苏。前瞻性收集了关于背景、临床特征和预后的数据。复苏患者与未复苏患者在年龄、性别、梗死部位或左心室功能方面无差异。复苏患者的总体1个月死亡率较高（14.3%对3.4%，P = 0.033），但非心脏性死亡率解释了全部差异（14.3%对1.2%，P = 0.001），而两组的心脏性死亡率同样较低（0对2.0%，P = 无显著性差异）。复苏患者预后不良的预测因素包括年龄较大（r = 0.47，P = 0.032）、未被目击的猝死（r = 0.44，P = 0.04）、心脏骤停发作至移动医疗单元到达（r = 0.67，P = 0.001）或自主循环恢复（r = 0.65，P = 0.001）的间隔时间较长、肾小球滤过率较低（r = -0.50，P = 0.02）以及初始心肌梗死溶栓血流分级（r = -0.51，P = 0.017）。