Xu James, Hee Leia, Hopkins Andrew, Juergens Craig P, Lo Sidney, French John K, Mussap Christian J
Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
Heart Lung Circ. 2019 Mar;28(3):370-378. doi: 10.1016/j.hlc.2018.01.005. Epub 2018 Feb 8.
Immediate cardiac catheterisation (CC) is recommended in ST-elevation myocardial infarction (STEMI) following sudden cardiac arrest (SCA). Guidelines advise urgent CC for SCA patients without-STEMI, at clinician discretion. We examined the clinical and angiographic factors predicting mortality in SCA patients having CC.
Consecutive SCA patients having CC at Liverpool Hospital, Sydney (January 2011-September 2015) were retrospectively analysed. Patient data were retrieved from hospital records, and angiographic SYNTAX scores (SS) were quantified online. Independent predictors of mortality were derived using multivariate logistic analysis.
The study cohort comprised 104 SCA patients; mean age 61±12years, and 79% male. Immediate CC (<2hours post-SCA) was performed in 35% overall. Compared to the without-STEMI subgroup, STEMI patients had more ventricular fibrillation (91 vs 50%; p<0.0001), and higher mean peak serum high-sensitivity troponin-T (8.25±14.7 vs 1.97±6.13 ug/L; p=0.006); in the context of higher median SS (18 vs 6.5; p=0.002) and target-lesion SS (tSS, 10 vs 0; p<0.001). Percutaneous coronary intervention (PCI; 75 vs 23%; p<0.0001) and target vessel revascularisation (11 vs 0%; p=0.005) were more frequent for STEMI. All-cause mortality was 39%, at 1.3±1.5years follow-up. Independent mortality predictors were: delayed CC (HR 4.08), serum lactate >7mmol/L (HR 3.47), and tSS (HR 1.05).
Elevated serum lactate, tSS, and delayed CC, were predictive of longer-term mortality in SCA patients having CC. Late CC in patients without-STEMI suggest scope for improvement in real-world systems of care. Closer scrutiny of target lesion complexity may aid prognostication in SCA survivors.
对于心脏骤停（SCA）后的ST段抬高型心肌梗死（STEMI）患者，建议立即进行心脏导管插入术（CC）。对于非STEMI的SCA患者，指南建议由临床医生酌情决定是否进行紧急CC。我们研究了接受CC的SCA患者中预测死亡率的临床和血管造影因素。
对悉尼利物浦医院（2011年1月至2015年9月）连续接受CC的SCA患者进行回顾性分析。从医院记录中检索患者数据，并在线量化血管造影SYNTAX评分（SS）。使用多因素逻辑分析得出死亡率的独立预测因素。
研究队列包括104例SCA患者；平均年龄61±12岁，男性占79%。总体上35%的患者进行了立即CC（SCA后<2小时）。与非STEMI亚组相比，STEMI患者有更多的室颤（91%对50%；p<0.0001），且平均血清高敏肌钙蛋白-T峰值更高（8.25±14.7对1.97±6.13μg/L；p=0.006）；同时中位数SS更高（18对6.5；p=0.002）以及靶病变SS（tSS，10对0；p<0.001）。STEMI患者的经皮冠状动脉介入治疗（PCI；75%对23%；p<0.0001）和靶血管血运重建（11%对0%；p=0.005）更为频繁。在1.3±1.5年的随访中，全因死亡率为39%。死亡率的独立预测因素为：延迟CC（HR 4.08）、血清乳酸>7mmol/L（HR 3.47）和tSS（HR 1.05）。
血清乳酸升高、tSS和延迟CC可预测接受CC的SCA患者的长期死亡率。非STEMI患者的延迟CC表明现实世界的医疗系统有改进空间。对靶病变复杂性进行更仔细的评估可能有助于SCA幸存者的预后判断。
