Winther-Jensen Matilde, Kjaergaard Jesper, Lassen Jens F, Køber Lars, Torp-Pedersen Christian, Hansen Steen M, Lippert Freddy, Kragholm Kristian, Christensen Erika F, Hassager Christian
1 Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark.
2 Department of Clinical Epidemiology, Aalborg University Hospital, Denmark.
Eur Heart J Acute Cardiovasc Care. 2017 Mar;6(2):144-154. doi: 10.1177/2048872616687115. Epub 2017 Jan 6.
The purpose of this study was to describe the implantation of implantable cardioverter defibrillator after out-of-hospital cardiac arrest caused by myocardial infarction in Denmark 2001-2012 and subsequent survival.
The Danish Cardiac Arrest Registry was used to identify patients ⩾18 years surviving to discharge without prior implantable cardioverter defibrillator. Information on cardioverter defibrillator implantation was obtained from the National Patient Registry.
We identified 974 myocardial infarction-out-of-hospital cardiac arrest patients surviving to hospital discharge, 130 of these patients (13%) had a cardioverter defibrillator implanted early (⩽40 days post-out-of-hospital cardiac arrest), 58 patients (6%) had late implantable cardioverter defibrillator (41-365 days post-out-of-hospital cardiac arrest). Odds of implantable cardioverter defibrillator implantation within one year were higher in patients receiving cardiopulmonary resuscitation (odds ratio (OR): 1.99, confidence interval (CI): 1.23-3.22, p=0.01), and Charlson Comorbidity Index level 1, (OR: 2.10, CI:1.25-3.49, p<0.01). Odds of a late implantable cardioverter defibrillator was higher in patients undergoing percutaneous coronary intervention (PCI) (OR: 3.67, CI: 1.35-9.97, p=0. 01). An early, but not late implantable cardioverter defibrillator was associated with increased survival (event time ratio: 1.45, CI: 1.11-1.90, p=0.01). Chronic heart failure, higher age groups, Charlson Comorbidity Index levels 1 to ⩾3 and male sex were associated with lower survival. Highest income was associated with higher survival.
Cardioverter defibrillator implantation rates in patients surviving an myocardial infarction-out-of-hospital cardiac arrest increased from 14% to 19% over the period. Of the total patient population, 13% had implantation earlier than recommended by guidelines, presumably as primary prevention of sudden cardiac death. Acute PCI and arrest later in the study period (increase one year) were predictors of late cardioverter defibrillator implantation. Early cardioverter defibrillator implantation was significantly associated with a long-term survival benefit, later implantation was not.
本研究旨在描述2001 - 2012年丹麦心肌梗死所致院外心脏骤停后植入式心脏复律除颤器的植入情况及后续生存率。
使用丹麦心脏骤停登记处来确定年龄≥18岁且在未植入过植入式心脏复律除颤器的情况下存活至出院的患者。心脏复律除颤器植入信息来自国家患者登记处。
我们确定了974例心肌梗死所致院外心脏骤停且存活至出院的患者，其中130例患者（13%）早期植入了心脏复律除颤器（院外心脏骤停后≤40天），58例患者（6%）晚期植入心脏复律除颤器（院外心脏骤停后41 - 365天）。接受心肺复苏的患者在1年内植入植入式心脏复律除颤器的几率更高（优势比（OR）：1.99，置信区间（CI）：1.23 - 3.22，p = 0.01），且Charlson合并症指数为1级的患者也是如此（OR：2.10，CI：1.25 - 3.49，p < 0.01）。接受经皮冠状动脉介入治疗（PCI）的患者植入晚期植入式心脏复律除颤器的几率更高（OR：3.67，CI：1.35 - 9.97，p = 0.01）。早期植入（而非晚期植入）植入式心脏复律除颤器与生存率提高相关（事件时间比：1.45，CI：1.11 - 1.90，p = 0.01）。慢性心力衰竭、较高年龄组、Charlson合并症指数1至≥3级以及男性与较低生存率相关。最高收入与较高生存率相关。
在此期间，心肌梗死所致院外心脏骤停存活患者的心脏复律除颤器植入率从14%增至19%。在全部患者中，13%的患者植入时间早于指南推荐时间，推测是作为心脏性猝死的一级预防。急性PCI以及研究后期（增加1年）的心脏骤停是晚期植入心脏复律除颤器的预测因素。早期植入心脏复律除颤器与长期生存获益显著相关，晚期植入则不然。
