院外心脏骤停患者长期生存的预测因素 - 倾向评分匹配分析。
Predicting factors for long-term survival in patients with out-of-hospital cardiac arrest - A propensity score-matched analysis.
机构信息
Department of Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany.
Department of Cardiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
出版信息
PLoS One. 2020 Jan 15;15(1):e0218634. doi: 10.1371/journal.pone.0218634. eCollection 2020.
BACKGROUND
Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death worldwide, with acute coronary syndromes accounting for most of the cases. While the benefit of early revascularization has been clearly demonstrated in patients with ST-segment-elevation myocardial infarction (STEMI), diagnostic pathways remain unclear in the absence of STEMI. We aimed to characterize OHCA patients presenting to 2 tertiary cardiology centers and identify predicting factors associated with survival.
METHODS
We retrospectively analyzed 519 patients after OHCA from February 2003 to December 2017 at 2 centers in Munich, Germany. Patients undergoing immediate coronary angiography (CAG) were compared to those without. Multivariate regression analysis and inverse probability treatment weighting (IPTW) were performed to identify predictors for improved outcome in a matched population.
RESULTS
Immediate CAG was performed in 385 (74.1%) patients after OHCA with presumed cardiac cause of arrest. As a result of multivariate analysis after propensity score matching, we found that immediate CAG, return of spontaneous circulation (ROSC) at admission, witnessed arrest and former smoking were associated with improved 30-days-survival [(OR, 0.46; 95% CI, 0.26-0.84), (OR, 0.21; 95% CI, 0.10-0.45), (OR, 0.50; 95% CI, 0.26-0.97), (OR, 0.43; 95% CI, 0.23-0.81)], and 1-year-survival [(OR, 0.39; 95% CI, 0.19-0.82), (OR, 0.29; 95% CI, 0.12-0.7), (OR, 0.43; 95% CI, 0.2-1.00), (OR, 0.3; 95% CI, 0.14-0.63)].
CONCLUSIONS
In our study, immediate CAG, ROSC at admission, witnessed arrest and former smoking were independent predictors of survival in cardiac arrest survivors. Improvement in prehospital management including bystander CPR and best practice post-resuscitation care with optimized triage of patients to an early invasive strategy may help ameliorate overall outcome of this critically-ill patient population.
背景
院外心脏骤停（OHCA）是全球主要死因之一，其中大多数由急性冠状动脉综合征引起。虽然 ST 段抬高型心肌梗死（STEMI）患者早期血运重建的益处已得到明确证实，但在没有 STEMI 的情况下，诊断途径仍不明确。我们旨在描述在德国慕尼黑的 2 个三级心脏病学中心就诊的 OHCA 患者，并确定与生存率相关的预测因素。
方法
我们回顾性分析了 2003 年 2 月至 2017 年 12 月期间在这 2 个中心因 OHCA 就诊的 519 例患者。比较了立即行冠状动脉造影（CAG）的患者与未行 CAG 的患者。采用多变量回归分析和逆概率治疗加权（IPTW）在匹配人群中识别改善预后的预测因素。
结果
在 519 例OHCA 疑似心源性停搏患者中，385 例（74.1%）患者行即刻 CAG。经倾向评分匹配后的多变量分析发现，即刻 CAG、入院时自主循环恢复（ROSC）、目击者停搏和既往吸烟与 30 天生存率的提高相关[比值比（OR），0.46；95%置信区间（CI），0.26-0.84），（OR），0.21；95%CI，0.10-0.45），（OR），0.50；95%CI，0.26-0.97），（OR），0.43；95%CI，0.23-0.81）]，1 年生存率[（OR），0.39；95%CI，0.19-0.82），（OR），0.29；95%CI，0.12-0.7），（OR），0.43；95%CI，0.2-1.00），（OR），0.3；95%CI，0.14-0.63）]。
结论
在我们的研究中，即刻 CAG、入院时 ROSC、目击者停搏和既往吸烟是心脏骤停幸存者生存的独立预测因素。改善包括旁观者 CPR 在内的院前管理以及最佳的复苏后护理，并优化对早期侵入性策略的患者分诊，可能有助于改善这一危重症患者群体的整体预后。
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