Division of Cardiovascular Medicine, University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033 USA.
J Invasive Cardiol. 2020 Mar;32(3):104-109. doi: 10.25270/jic/19.00311. Epub 2020 Jan 15.
Recent studies suggest that primary percutaneous coronary intervention (PCI) and targeted temperature management (TTM) improve outcome in ST-segment elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA). The objective of this study was to evaluate a contemporary series of patients with STEMI and OHCA to characterize treatment approaches and predictors of neurologic outcome.
From January 2009 through November 2012, a total of 239 patients who underwent emergent coronary angiography at 10 medical centers across the United States were enrolled. All patients suffered OHCA with STEMI on either the prehospital or post-resuscitation electrocardiogram. Neurologic outcome was assessed using the cerebral performance category (CPC) score. Predictors of neurologic outcome were determined using multivariate logistic regression analysis. The primary endpoint was in-hospital survival with good neurologic function (CPC score 1 or 2).
Mean age was 60 ± 13 years, 72% were male, and the majority of patients had a history of cardiovascular event. Initial rhythm was ventricular fibrillation in 72%. At hospital presentation, 76% of patients were intubated, 37% were in cardiogenic shock, and 33% were receiving vasopressors. Primary PCI was performed in 74%, with an average door-to-balloon time of 95 ± 77 minutes, and TTM was used in 51%. Forty-four percent of patients had full neurologic recovery (CPC score 1) and 55% had good neurologic function. Overall in-hospital survival rate was 66%. Independent predictors of in-hospital survival with good neurologic function were: receiving bystander cardiopulmonary resuscitation, location of arrest, receiving drug-eluting stents, and not experiencing a recurrent cardiac arrest.
Short-term survival for patients with STEMI and OHCA undergoing emergent coronary angiography and revascularization with TTM in this contemporary, multicenter registry was high and neurologic outcome was good in more than half of patients.
最近的研究表明，直接经皮冠状动脉介入治疗（PCI）和目标温度管理（TTM）可改善伴有院外心脏骤停（OHCA）的 ST 段抬高型心肌梗死（STEMI）患者的预后。本研究的目的是评估一组具有 STEMI 和 OHCA 的当代患者，以描述治疗方法和神经功能预后的预测因素。
2009 年 1 月至 2012 年 11 月，在美国 10 家医疗中心共纳入 239 名接受紧急冠状动脉造影的患者。所有患者均在院前或复苏后心电图上发生 OHCA 伴 STEMI。神经功能预后采用脑功能分类（CPC）评分进行评估。使用多变量逻辑回归分析确定神经功能预后的预测因素。主要终点是住院期间存活且神经功能良好（CPC 评分 1 或 2）。
平均年龄为 60±13 岁，72%为男性，大多数患者有心血管事件史。初始节律为 72%的室颤。入院时，76%的患者插管，37%的患者心源性休克，33%的患者使用升压药。74%的患者接受了直接 PCI，门球时间平均为 95±77 分钟，51%的患者使用了 TTM。44%的患者完全恢复神经功能（CPC 评分 1），55%的患者神经功能良好。总的院内存活率为 66%。院内存活率良好的独立预测因素包括：接受旁观者心肺复苏、停搏部位、接受药物洗脱支架和未发生再次心脏骤停。
在这个当代多中心注册研究中，接受紧急冠状动脉造影和 TTM 血运重建的 STEMI 和 OHCA 患者的短期存活率较高，超过一半的患者神经功能良好。
