Division of Cardiology, University Hospital, Santa Maria della Misericordia, Udine, Italy.
Am J Cardiol. 2012 Dec 15;110(12):1723-8. doi: 10.1016/j.amjcard.2012.08.006. Epub 2012 Sep 10.
Acute coronary thrombotic occlusion is the most common trigger of cardiac arrest. The aim of the present study was to assess the impact of an invasive strategy characterized by emergency coronary angiography and subsequent percutaneous coronary intervention (PCI), if indicated, on in-hospital survival of resuscitated patients with out-of-hospital cardiac arrest (OHCA) and no obvious extracardiac cause who do not regain consciousness soon after recovery of spontaneous circulation. Ninety-three consecutive patients (67 ± 12 years old, 76% men) were included in the study. Clinical characteristics and coronary angiographic and in-hospital outcome data were retrospectively collected. Multivariate Cox proportional-hazards analysis was performed to identify independent determinants of in-hospital survival. Coronary angiography was performed in 66 patients (71%). Forty-eight patients underwent emergency coronary angiography; in the remaining 18 patients, mean time from OHCA to coronary angiography was 13 ± 10 days. In patients referred to emergency coronary angiography, successful emergency PCI of a culprit coronary lesion was performed in 25 patients (52%). In-hospital survival rate was 54%. At multivariate analysis, emergency coronary angiography (hazard ratio 2.32, 95% confidence interval 1.23 to 4.38, p = 0.009) and successful emergency PCI (hazard ratio 2.54, 95% confidence interval 1.35 to 4.8, p = 0.004) were independently related to in-hospital survival in the overall study population; delay in performing coronary angiography (hazard ratio 0.95, 95% confidence interval 0.92 to 0.99, p = 0.013) was independently related to in-hospital mortality in patients referred to coronary angiography. In conclusion, an invasive strategy characterized by emergency coronary angiography and subsequent PCI, if indicated, seems to improve in-hospital outcome of resuscitated but unconscious patients with OHCA without obvious extracardiac cause.
急性冠状动脉血栓性闭塞是心脏骤停最常见的诱因。本研究旨在评估以紧急冠状动脉造影和随后的经皮冠状动脉介入治疗（PCI，如果有指征）为特征的侵入性策略对复苏后无意识的院外心脏骤停（OHCA）且无明显心外原因且自发循环恢复后不久未恢复意识的患者的院内生存率的影响。研究纳入了 93 例连续患者（67 ± 12 岁，76%为男性）。回顾性收集临床特征、冠状动脉造影和院内转归数据。采用多变量 Cox 比例风险分析确定院内生存率的独立决定因素。对 66 例患者（71%）进行了冠状动脉造影。48 例患者行紧急冠状动脉造影术；在其余 18 例患者中，从 OHCA 到冠状动脉造影的平均时间为 13 ± 10 天。在紧急冠状动脉造影术的患者中，25 例（52%）成功进行了罪犯冠状动脉病变的紧急 PCI。院内生存率为 54%。多变量分析显示，紧急冠状动脉造影术（危险比 2.32，95%置信区间 1.23 至 4.38，p = 0.009）和成功的紧急 PCI（危险比 2.54，95%置信区间 1.35 至 4.8，p = 0.004）与整个研究人群的院内生存率独立相关；进行冠状动脉造影术的延迟（危险比 0.95，95%置信区间 0.92 至 0.99，p = 0.013）与接受冠状动脉造影术的患者的院内死亡率独立相关。总之，以紧急冠状动脉造影和随后的 PCI（如果有指征）为特征的侵入性策略似乎可以改善复苏后无意识的 OHCA 且无明显心外原因患者的院内预后。
