Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiology, Albany Medical College, Albany, New York.
JACC Clin Electrophysiol. 2019 Jul;5(7):843-850. doi: 10.1016/j.jacep.2019.04.003. Epub 2019 May 29.
This study sought to investigate the impact of the neurological status of sudden cardiac arrest (SCA) survivors on implantable cardioverter-defibrillator (ICD) insertion and long-term mortality.
The neurological status of SCA survivors may impact the decision to insert an ICD insertion and influence long-term survival.
In 1,433 survivors of SCA between 2002 and 2012, we examined the neurological status immediately after the arrest using the Pittsburgh Cardiac Arrest Category (PCAC) and prior to hospital discharge using the cerebral performance category (CPC) score. Patients were followed up to the endpoints of ICD implantation and all-cause mortality.
Over a median follow-up period of 3.6 years, 389 (27%) patients received an ICD, and 674 (47%) died. The PCAC (adjusted hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.69 to 0.90) and CPC (adjusted HR: 0.73; 95% CI: 0.64 to 0.84) scores were highly predictive of the time to ICD insertion and of all-cause mortality (PCAC score, adjusted HR: 1.39; 95% CI: 1.24 to 1.57; CPC score, adjusted HR: 2.03; 95% CI: 1.77 to 2.34). ICD therapy was associated with better survival even after adjusting for neurological status (HR: 0.56; 95% CI: 0.43 to 0.73). A significant proportion of patients in the worse CPC categories had a >1-year survival after the index SCA.
In SCA survivors, worse neurological performance was associated with lower likelihood of ICD insertion and higher mortality. ICD insertion was associated with improved survival even after accounting for neurological performance. ICD discussion should therefore not be omitted in these patients.
本研究旨在探讨心搏骤停（SCA）幸存者的神经状态对植入式心律转复除颤器（ICD）植入和长期死亡率的影响。
SCA 幸存者的神经状态可能会影响 ICD 植入的决策，并影响长期生存。
在 2002 年至 2012 年间的 1433 例 SCA 幸存者中，我们使用匹兹堡心脏骤停分类（PCAC）评估心脏骤停后即刻的神经状态，使用脑功能分类（CPC）评分评估出院前的神经状态。患者的随访终点为 ICD 植入和全因死亡率。
在中位随访 3.6 年期间，389 例（27%）患者植入了 ICD，674 例（47%）死亡。PCAC（调整后的危险比[HR]：0.79；95%置信区间[CI]：0.69 至 0.90）和 CPC（调整后的 HR：0.73；95%CI：0.64 至 0.84）评分对 ICD 植入时间和全因死亡率均有高度预测性（PCAC 评分，调整后的 HR：1.39；95%CI：1.24 至 1.57；CPC 评分，调整后的 HR：2.03；95%CI：1.77 至 2.34）。即使在调整了神经状态后，ICD 治疗也与更好的生存相关（HR：0.56；95%CI：0.43 至 0.73）。在指数 SCA 后，许多 CPC 较差类别的患者仍有超过 1 年的生存。
在 SCA 幸存者中，神经功能越差，ICD 植入的可能性越低，死亡率越高。即使考虑到神经功能表现，ICD 植入也与生存改善相关。因此，在这些患者中不应省略 ICD 讨论。
