Emergency Medical Services Division of Public Health for Seattle and King County, Seattle, WA 98104, USA.
J Am Coll Cardiol. 2012 Jul 3;60(1):21-7. doi: 10.1016/j.jacc.2012.03.036.
The aim of the study was to assess the influence of percutaneous coronary intervention (PCI) and therapeutic hypothermia (TH) on long-term prognosis.
Although hospital care consisting of TH and/or PCI in particular patients resuscitated following out-of-hospital cardiac arrest (OHCA) can improve survival to hospital discharge, there is little evidence regarding how these therapies may impact long-term prognosis.
We performed a cohort investigation of all persons >18 years of age who suffered nontraumatic OHCA and were resuscitated and discharged alive from the hospital between January 1, 2001, and December 31, 2009, in a metropolitan emergency medical service (EMS) system. We reviewed EMS and hospital records, state death certificates, and the national death index to determine clinical characteristics and vital status. Survival analyses were conducted using Kaplan-Meier estimates and multivariable Cox regression. Analyses of TH were restricted to those patients who were comatose at hospital admission.
Of the 5,958 persons who received EMS-attempted resuscitation, 1,001 (16.8%) were discharged alive from the hospital. PCI was performed in 384 of 1,001 (38.4%), whereas TH was performed in 241 of 941 (25.6%) persons comatose at hospital admission. Five-year survival was 78.7% among those treated with PCI compared with 54.4% among those not receiving PCI and 77.5% among those treated with TH compared with 60.4% among those not receiving TH (both p < 0.001). After adjustment for confounders, PCI was associated with a lower risk of death (hazard ratio [HR]: 0.46 [95% confidence interval [CI]: 0.34 to 0.61]; p < 0.001). Likewise, TH was associated with a lower risk of death (HR: 0.70 [95% CI: 0.50 to 0.97]; p = 0.04).
The findings suggested that effects of acute hospital interventions for post-resuscitation treatment extend beyond hospital survival and can positively influence prognosis following the arrest hospitalization.
本研究旨在评估经皮冠状动脉介入治疗（PCI）和治疗性低温（TH）对长期预后的影响。
尽管在院外心脏骤停（OHCA）后接受包括 TH 和/或 PCI 的特定患者的医院治疗可以提高出院时的生存率，但关于这些治疗方法如何影响长期预后的证据很少。
我们对 2001 年 1 月 1 日至 2009 年 12 月 31 日期间在大都市急救医疗服务（EMS）系统中接受过非创伤性 OHCA 且复苏后存活并出院的所有 >18 岁患者进行了队列研究。我们回顾了 EMS 和医院记录、州死亡证明和国家死亡索引，以确定临床特征和生存状态。使用 Kaplan-Meier 估计和多变量 Cox 回归进行生存分析。TH 分析仅限于入院时昏迷的患者。
在接受 EMS 尝试复苏的 5958 人中，有 1001 人（16.8%）从医院出院存活。在 1001 名出院患者中，有 384 名（38.4%）接受了 PCI，而在 941 名入院时昏迷的患者中，有 241 名（25.6%）接受了 TH。接受 PCI 治疗的患者 5 年生存率为 78.7%，而未接受 PCI 治疗的患者为 54.4%，接受 TH 治疗的患者为 77.5%，而未接受 TH 治疗的患者为 60.4%（均<0.001）。在校正混杂因素后，PCI 与死亡风险降低相关（风险比[HR]：0.46[95%置信区间[CI]：0.34 至 0.61]；<0.001）。同样，TH 与死亡风险降低相关（HR：0.70[95% CI：0.50 至 0.97]；p=0.04）。
研究结果表明，复苏后急性医院干预的效果不仅限于医院生存，而且可以积极影响复苏住院后的预后。
