急性心肌梗死并发院外心脏骤停患者的长期生存：一项前瞻性队列研究。
Long-term survival in patients with acute myocardial infarction and out-of-hospital cardiac arrest: A prospective cohort study.
机构信息
Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway.
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, P.O. Box 1122 Blindern, 0317 Oslo, Norway.
出版信息
Resuscitation. 2018 Jan;122:41-47. doi: 10.1016/j.resuscitation.2017.11.047. Epub 2017 Nov 17.
AIM
To compare short- and long-term survival in patients admitted to hospital after acute myocardial infarction (AMI) with and without out-of-hospital cardiac arrest (OHCA).
METHODS
Prospective cohort study of all AMI patients admitted to Oslo University Hospital Ulleval from September 1, 2005 to December 31, 2011. All-cause mortality was obtained from the Norwegian Cause of Death Registry with censoring date December 31, 2013. Cumulative survival was assessed with the Kaplan-Meier and the Life-table method. Logistic- and Cox regression were used for risk comparisons.
RESULTS
We identified 404 AMI patients with OHCA and 9425 AMI patients without. AMI patients without OHCA were categorized as ST-elevation myocardial infarction (STEMI, n=4522) or non-STEMI (NSTEMI, n=4903). Mean age was 63.6±standard deviation (SD) 12.5, 63.8±13.1 and 69.7±13.6 years in OHCA, STEMI and NSTEMI, respectively. Coronary angiography with subsequent percutaneous coronary intervention if indicated, was performed in 87% of OHCA, 97% of STEMI and 80% of NSTEMI patients. Thirty-day survival was 63%, 94% and 94%, and 8-year survival was 49%, 74%, and 57%, respectively. Among patients surviving the first 30days, no significant difference in risk during long-term follow-up was found (adjusted Hazard Ratio (aHR) 1.15 [95% CI 0.82-1.60], aHR 0.89 [95% CI 0.64-1.24]).
CONCLUSIONS
Long-term survival after OHCA due to AMI was good, with 49% of admitted patients being alive after eight years. Although short-term mortality remained high, OHCA patients alive after 30days had similar long-term risk as AMI patients without OHCA.
目的
比较因急性心肌梗死（AMI）入院的伴有和不伴有院外心脏骤停（OHCA）患者的短期和长期生存情况。
方法
对 2005 年 9 月 1 日至 2011 年 12 月 31 日期间入住奥斯陆大学医院 Ulleval 的所有 AMI 患者进行前瞻性队列研究。所有原因的死亡率均从挪威死因登记处获得，并于 2013 年 12 月 31 日截止。使用 Kaplan-Meier 和寿命表法评估累积生存率。使用逻辑回归和 Cox 回归进行风险比较。
结果
我们确定了 404 例伴有 OHCA 的 AMI 患者和 9425 例不伴有 OHCA 的 AMI 患者。不伴有 OHCA 的 AMI 患者分为 ST 段抬高型心肌梗死（STEMI，n=4522）或非 ST 段抬高型心肌梗死（NSTEMI，n=4903）。OHCA、STEMI 和 NSTEMI 患者的平均年龄分别为 63.6±12.5 岁、63.8±13.1 岁和 69.7±13.6 岁。如果有指征，对 87%的 OHCA、97%的 STEMI 和 80%的 NSTEMI 患者进行了冠状动脉造影术和随后的经皮冠状动脉介入治疗。30 天生存率分别为 63%、94%和 94%，8 年生存率分别为 49%、74%和 57%。在存活 30 天的患者中，在长期随访期间未发现风险存在显著差异（调整后的危险比[aHR]1.15[95%置信区间 0.82-1.60]，aHR 0.89[95%置信区间 0.64-1.24]）。
结论
AMI 所致 OHCA 后的长期生存率良好，8 年后有 49%的入院患者存活。尽管短期死亡率仍然很高，但存活 30 天后的 OHCA 患者与不伴有 OHCA 的 AMI 患者具有相似的长期风险。
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