Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, CA, USA.
Am J Cardiol. 2013 May 1;111(9):1253-8. doi: 10.1016/j.amjcard.2013.01.267. Epub 2013 Feb 5.
Prompt percutaneous coronary intervention is associated with improved survival in patients presenting with cardiac arrest. Few studies, however, have focused on patients with cardiac arrest not selected for coronary angiography. The aim of the present study was to evaluate the clinical characteristics and outcomes of patients with cardiac arrest denied emergent angiography. Patients with cardiac arrest were identified within a registry that included all catheterization laboratory activations from 2008 to 2012. Logistic regression and proportional-hazards models were created to assess the clinical characteristics and mortality associated with denying emergent angiography. Among 664 patients referred for catheterization, 110 (17%) had cardiac arrest, and 26 of these patients did not undergo emergent angiography. Most subjects (69%) were turned down for angiography for clinical reasons and a minority for perceived futility (27%). After multivariate adjustment, pulseless electrical activity as the initial arrest rhythm (adjusted odds ratio [AOR] 13.27, 95% confidence interval [CI] 1.76 to 100.12), <1.0 mm of ST-segment elevation (AOR 10.26, 95% CI 1.68 to 62.73), female gender (AOR 4.45, 95% CI 1.04 to 19.08), and advancing age (AOR 1.10 per year, 95% CI 1.04 to 1.16) were associated with increased odds of withholding angiography. The mortality rate was markedly higher for patients who were denied emergent angiography (hazard ratio 3.64, 95% CI 2.05 to 6.49), even after adjustment for medical acuity (hazard ratio 2.29, 95% CI 1.19 to 4.41). In conclusion, older subjects, women, and patients without ST-segment elevation were more commonly denied emergent angiography after cardiac arrest. Patients denied emergent angiography had increased mortality that persisted after adjustment for illness severity.
经皮冠状动脉介入治疗与改善心搏骤停患者的生存率相关。然而，很少有研究关注未选择进行冠状动脉造影的心搏骤停患者。本研究旨在评估拒绝紧急血管造影的心搏骤停患者的临床特征和结局。从 2008 年至 2012 年的所有导管实验室激活中确定了心搏骤停患者。使用逻辑回归和比例风险模型评估与拒绝紧急血管造影相关的临床特征和死亡率。在 664 例接受导管插入术的患者中，110 例（17%）发生心搏骤停，其中 26 例未进行紧急血管造影。大多数患者（69%）因临床原因被拒绝进行血管造影，少数患者（27%）因认为无效而被拒绝。多变量调整后，无脉性电活动作为初始停搏节律（调整后的优势比 [OR] 13.27，95%置信区间 [CI] 1.76 至 100.12）、＜1.0mm 的 ST 段抬高（调整后的 OR 10.26，95%CI 1.68 至 62.73）、女性（调整后的 OR 4.45，95%CI 1.04 至 19.08）和年龄增长（每年增加 1.10，95%CI 1.04 至 1.16）与增加拒绝血管造影的可能性相关。拒绝紧急血管造影的患者死亡率明显更高（危险比 3.64，95%CI 2.05 至 6.49），即使在调整医疗严重程度后（危险比 2.29，95%CI 1.19 至 4.41）。总之，年龄较大的患者、女性和无 ST 段抬高的患者在发生心搏骤停后更常被拒绝紧急血管造影。拒绝紧急血管造影的患者死亡率增加，即使在调整疾病严重程度后仍持续存在。
