London Chest Hospital, Barts Health NHS Trust, UK National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Barts Health NHS Trust, UK.
London Chest Hospital, Barts Health NHS Trust, UK.
Eur Heart J Acute Cardiovasc Care. 2015 Aug;4(4):378-85. doi: 10.1177/2048872614555990. Epub 2014 Oct 17.
Current recommendations are for primary percutaneous coronary intervention (pPCI) in ST-elevation myocardial infarction (STEMI) complicated by out of hospital cardiac arrest (OHCA). However, information about longer-term outcomes is sparse, particularly among high-risk patients who do not regain consciousness promptly after resuscitation.
Of 1836 consecutive patients admitted with STEMI for pPCI between April 2008-October 2011, 132 (7.2%) who had suffered OHCA with recovery of spontaneous circulation (ROSC) form the study population. 101 patients survived to hospital discharge (76.5%) with only one further death in the first year. Prognosis was worse for the 62 patients who were unconscious on arrival and required admission to the intensive therapy unit (ITU), only 54% of whom survived. Every additional minute in the time to ROSC increased the hazard of death by 1.7% while alertness upon ROSC and successful reperfusion in response to pPCI reduced the hazard of death by 90% and 65% respectively. Full neurological recovery was recorded in 85.1% of those who survived to be discharged but in only 30.6% of the 34 survivors who were admitted unconscious and received ITU treatment. Every additional minute in the time to ROSC increased the odds of neurological deficit by 7.0%.
In patients with STEMI who are conscious after OHCA, high rates of survival can be achieved with pPCI, depending in part on the time it takes for ROSC. Prognosis is less good in the subgroup brought to hospital unconscious but even in this high risk group neurologically intact survival can be achieved in about one-third of cases, suggesting the benefit of immediate pPCI in STEMI patients successfully resuscitated after OHCA.
目前的建议是对 ST 段抬高型心肌梗死（STEMI）并发院外心脏骤停（OHCA）的患者进行直接经皮冠状动脉介入治疗（pPCI）。然而，关于长期预后的信息很少，特别是在那些在复苏后未能迅速恢复意识的高危患者中。
在 2008 年 4 月至 2011 年 10 月期间，连续 1836 例因 pPCI 入院的 STEMI 患者中，有 132 例（7.2%）发生 OHCA 并恢复自主循环（ROSC），这 132 例患者来自研究人群。101 例患者存活至出院（76.5%），在第一年只有 1 例进一步死亡。对于入院时无意识且需要入住重症监护病房（ITU）的 62 例患者，预后更差，只有 54%的患者存活。ROSC 时间每增加 1 分钟，死亡的风险增加 1.7%，而 ROSC 时的清醒和 pPCI 后的成功再灌注分别降低 90%和 65%的死亡风险。存活至出院的患者中有 85.1%记录到完全神经恢复，但在 34 例无意识存活且接受 ITU 治疗的幸存者中，只有 30.6%记录到完全神经恢复。ROSC 时间每增加 1 分钟，神经功能缺陷的几率增加 7.0%。
在 OHCA 后意识清醒的 STEMI 患者中，pPCI 可实现高存活率，部分取决于 ROSC 所需的时间。在无意识入院的亚组中，预后较差，但即使在这个高危人群中，大约三分之一的患者仍能实现神经功能完整的存活，这表明在 OHCA 成功复苏后的 STEMI 患者中立即进行 pPCI 是有益的。
