Moutacalli Z, Georges J-L, Ajlani B, Cherif G, El Beainy E, Gibault-Genty G, Blicq E, Charbonnel C, Convers-Domart R, Boutot F, Caussanel J-M, Lemaire B, Legriel S, Livarek B
Service de cardiologie, centre hospitalier de Versailles, 78150 Le-Chesnay, France.
Service de cardiologie, centre hospitalier de Versailles, 78150 Le-Chesnay, France.
Ann Cardiol Angeiol (Paris). 2017 Nov;66(5):260-268. doi: 10.1016/j.ancard.2017.09.008. Epub 2017 Oct 10.
Immediate coronary angiography (iCA) and primary percutaneous coronary angioplasty (pPCI) in patients successfully resuscitated after out-of-hospital cardiac arrest (OHCA) of suspected cardiac cause is controversial. Our aims were to assess the results of iCA, the prognostic impact of pPCI after OHCA, and to identify subgroups most likely to benefit from this strategy.
In this single-centre retrospective study, patients aged ≥18 years with sustained return of spontaneous circulation after OHCA and no evidence of a non-cardiac cause underwent routine iCA at admission, with pPCI if indicated. Results of iCA, and factors associated with in-hospital survival were analysed.
Between 2006 and 2013, 160 survivors from OHCA presumed of cardiac origin were included (median age, 60 years; 85% males). iCA showed significant coronary-artery lesions in 75% of patients, and acute occlusion or unstable lesion in only 41%. pPCI was performed in 34% of patients and was not associated with survival by univariate or multivariate analysis (P=0.67). ST-segment elevation predicted acute coronary occlusion in 40%. An initial shockable rhythm was associated with higher in-hospital survival (52% vs. 19%; P<0.001). After initial defibrillation, the first rhythm recorded by 12-lead electrocardiography was highly associated with prognosis: secondary asystole had a very low survival rate (5%, 1/21) despite PCI in 43% of patients, compared to sustained ventricular tachycardia/fibrillation (42%, 15/36) and supraventricular rhythm (71%, 50/70) (P<0.001).
In our experience, the prevalence of acute coronary occlusion or unstable lesion immediately after OHCA of likely cardiac cause is only 41%. Immediate CA in OHCA survivors, with pPCI if indicated, should be restricted to highly selected patients.
对于疑似心源性院外心脏骤停（OHCA）后成功复苏的患者，立即进行冠状动脉造影（iCA）和直接经皮冠状动脉介入治疗（pPCI）存在争议。我们的目的是评估iCA的结果、OHCA后pPCI对预后的影响，并确定最有可能从该策略中获益的亚组。
在这项单中心回顾性研究中，年龄≥18岁、OHCA后自主循环持续恢复且无非心源性病因证据的患者在入院时接受常规iCA，如有指征则进行pPCI。分析iCA的结果以及与院内生存相关的因素。
2006年至2013年期间，纳入了160例推测为心源性OHCA的幸存者（中位年龄60岁；85%为男性）。iCA显示75%的患者存在显著冠状动脉病变，而急性闭塞或不稳定病变仅占41%。34%的患者接受了pPCI，单因素或多因素分析均未发现其与生存相关（P = 0.67）。ST段抬高预测40%的患者存在急性冠状动脉闭塞。初始可电击心律与较高的院内生存率相关（52%对19%；P < 0.001）。首次除颤后，12导联心电图记录的首个心律与预后高度相关：继发性心脏停搏的生存率极低（5%，1/21），尽管43%的患者接受了PCI，而持续性室性心动过速/心室颤动（42%，15/36）和室上性心律（71%，50/70）的生存率则较高（P < 0.001）。
根据我们的经验，可能心源性OHCA后立即出现急性冠状动脉闭塞或不稳定病变的发生率仅为41%。OHCA幸存者的立即冠状动脉造影（如有指征则进行pPCI）应仅限于经过严格筛选的患者。
