Yarmohammadi Hirad, Uy-Evanado Audrey, Reinier Kyndaron, Rusinaru Carmen, Chugh Harpriya, Jui Jonathan, Chugh Sumeet S
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Mayo Clin Proc. 2017 Oct;92(10):1479-1485. doi: 10.1016/j.mayocp.2017.05.028. Epub 2017 Sep 21.
To evaluate the potential role of low serum Ca levels in the occurrence of sudden cardiac arrest (SCA) in the community.
We compared 267 SCA cases [177 (66%) men] and 445 controls [314 (71%) men] from a large population-based study (catchment population ∼1 million individuals) in the US Northwest from February 1, 2002, through December 31, 2015. Patients were included if their age was 18 years or older with available creatinine clearance (CrCl) and serum electrolyte levels for analyses to enable adjustment for renal function. For cases, creatinine clearance and electrolyte levels were required to be measured within 90 days of the SCA event.
Cases of SCA had higher proportions of blacks [31 (12%) vs 14 (3%); P<.001], diabetes mellitus [122 (46%) vs 126 (28%); P<.001], and chronic kidney disease [102 (38%) vs 73 (16%); P<.001] than did controls. In multivariable logistic regression analysis, a 1-unit decrease in Ca levels was associated with a 1.6-fold increase in odds of SCA (odds ratio, 1.63; 95% CI, 1.06-2.51). Blood Ca levels lower than 8.95 mg/dL (to convert to mmol/L, multiply by 0.025) were associated with a 2.3-fold increase in odds of SCA as compared with levels higher than 9.55 mg/dL (odds ratio, 2.33; 95% CI, 1.17-4.61). Cases of SCA had significantly prolonged corrected QT intervals on the 12-lead electrocardiogram than did controls (465±37 ms vs 425±33 ms; P<.001).
Lower serum Ca levels were independently associated with an increased risk of SCA in the community.
评估低血清钙水平在社区心脏骤停（SCA）发生中的潜在作用。
我们比较了2002年2月1日至2015年12月31日期间美国西北部一项基于人群的大型研究（集水区人口约100万）中的267例SCA病例[177例（66%）男性]和445例对照[314例（71%）男性]。年龄在18岁及以上且有可用的肌酐清除率（CrCl）和血清电解质水平用于分析以调整肾功能的患者被纳入研究。对于病例，肌酐清除率和电解质水平需在SCA事件发生后90天内测量。
与对照组相比，SCA病例中黑人比例更高[31例（12%）对14例（3%）；P<0.001]、糖尿病患者比例更高[122例（46%）对126例（28%）；P<0.001]、慢性肾病患者比例更高[102例（38%）对73例（16%）；P<0.001]。在多变量逻辑回归分析中，钙水平每降低1个单位，SCA发生几率增加1.6倍（比值比，1.63；95%置信区间，1.06 - 2.51）。与高于9.55mg/dL的水平相比，低于8.95mg/dL的血钙水平（换算为mmol/L时，乘以0.025）与SCA发生几率增加2.3倍相关（比值比，2.33；95%置信区间，1.17 - 4.61）。SCA病例的12导联心电图校正QT间期明显长于对照组（465±37毫秒对425±33毫秒；P<0.001）。
较低的血清钙水平与社区中SCA风险增加独立相关。
