Service de Réanimation Médicale et Toxicologique, Université de Paris, APHP, Lariboisière Hospital, 2 rue Ambroise Paré, 75475 Paris, France; INSERM UMRS - 1144, Paris, France.
Service de Cardiologie, Université de Paris, APHP, Lariboisière Hospital, 2 rue Ambroise Paré, 75475 Paris, France; Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine of the Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
Resuscitation. 2020 Oct;155:226-233. doi: 10.1016/j.resuscitation.2020.06.022. Epub 2020 Jul 3.
Coronary angiogram (CA) may be useful after resuscitated out-of-hospital cardiac arrest (OHCA), but data regarding its benefit in patients with non-shockable initial rhythm without ST-segment elevation is scarce. We aimed to evaluate the prevalence of acute coronary syndrome (ACS) and survival in OHCA patients with non-shockable initial rhythm without ST-segment elevation and compare them to patients with shockable initial rhythm without ST-segment elevation.
Retrospective single-centre study approved by the ethics committee of our institution, including adults successfully resuscitated from OHCA of presumed cardiac cause, undergoing routine CA on admission. Baseline characteristics, angiographic data including presence of ACS and survival were compared between patients with non-shockable and shockable initial rhythm focusing on patients without ST-segment elevation.
Among 517 patients included between 2002 and 2018, 311 had no ST-elevation, of whom 179 had non-shockable and 132 shockable initial rhythm. Compared with shockable initial rhythm patients without ST-elevation, non-shockable initial rhythm patients without ST-elevation had longer no-flow duration, 5 (1-10) versus 2 (0-8) min, p = 0.024, more frequent shock requiring vasopressors, 72% versus 47% p < 0.0001, a lower prevalence of ACS, 2 (1%), versus 29 (22%), p < 0.001 and higher mortality, 85% versus 39% (p < 0.0001). Among ACS patients, none survived in the non-shockable without ST-elevation group, while 20 (69%) survived in the shockable rhythm without ST-elevation group.
Prevalence of ACS in patients without ST-segment elevation and non-shockable initial rhythm is extremely low, and survival extremely poor, therefore routine emergency CA does not seem beneficial in these patients.
经心肺复苏后成功救治的院外心脏骤停（OHCA）患者行冠状动脉造影（CA）可能有益，但对于初始非颤动感律且无 ST 段抬高的患者，CA 获益的数据却很少。本研究旨在评估初始非颤动感律且无 ST 段抬高的 OHCA 患者中急性冠状动脉综合征（ACS）的发生率和存活率，并与初始颤动感律且无 ST 段抬高的患者进行比较。
这是一项回顾性单中心研究，在获得我院伦理委员会批准后，纳入了 2002 年至 2018 年期间因疑似心源性原因成功复苏的 OHCA 成年患者，这些患者入院时均接受了常规 CA。对比初始非颤动感律和初始颤动感律患者的基线特征、包括 ACS 存在情况和存活率，重点关注无 ST 段抬高的患者。
在纳入的 517 例患者中，有 311 例无 ST 段抬高，其中 179 例为初始非颤动感律，132 例为初始颤动感律。与初始颤动感律无 ST 段抬高的患者相比，初始非颤动感律无 ST 段抬高的患者无复流时间更长，5（1-10）min 比 2（0-8）min，p=0.024；需要升压药的休克更频繁，72%比 47%，p<0.0001；ACS 发生率更低，2（1%）比 29（22%），p<0.001；死亡率更高，85%比 39%，p<0.0001。在 ACS 患者中，无 ST 段抬高且初始非颤动感律组无一例存活，而无 ST 段抬高且初始颤动感律组有 20 例（69%）存活。
无 ST 段抬高且初始非颤动感律患者的 ACS 发生率极低，存活率极差，因此，常规急诊 CA 似乎对这些患者无益。
