Matsumura Koichiro, Kin Hiromi, Fujii Kenichi, Shibutani Hiroki, Matsumoto Hiroshi, Otagaki Munemitsu, Yokoi Mitsuru, Yamamoto Yoshihiro, Sugiura Tetsuro, Shiojima Ichiro
Department of Cardiology, Kansai Medical University Medical Center Osaka Japan.
Division of Cardiology, Department of Medicine II, Kansai Medical University Osaka Japan.
Circ Rep. 2019 Jul 25;1(8):320-325. doi: 10.1253/circrep.CR-19-0055.
The aim of this study was to evaluate the clinical ability of coronary artery calcium (CAC) score to identify acute myocardial infarction (AMI) in survivors of out-of-hospital cardiac arrest (OHCA). We studied 180 consecutive survivors of OHCA who underwent immediate non-contrast computed tomography (CT) and coronary angiography. Seventy-one patients had ST elevation or left bundle branch block (LBBB; group 1) and 109 patients did not have ST elevation or LBBB (group 2) on post-resuscitation electrocardiogram (ECG). CAC score was significantly higher in AMI compared with non-AMI in groups 1 and 2. The optimal cut-off of CAC score to identify AMI was 11.5 (sensitivity, 80%; specificity, 71%) in group 1, and 27.4 (sensitivity, 80%; specificity, 76%) in group 2. On multivariate analysis, CAC score was the strongest predictive marker of AMI (OR, 10.91; 95% CI: 6.00-25.97). In addition, CAC score was an independent predictor of 30-day survival (OR, 0.38; 95% CI: 0.15-0.95). Evaluation of CAC is a useful method to identify AMI in survivors of OHCA, regardless of ST changes on post-resuscitation ECG.
本研究的目的是评估冠状动脉钙化（CAC）评分在识别院外心脏骤停（OHCA）幸存者急性心肌梗死（AMI）方面的临床能力。我们研究了180例连续的OHCA幸存者，这些患者接受了即时非增强计算机断层扫描（CT）和冠状动脉造影。71例患者在复苏后心电图（ECG）上有ST段抬高或左束支传导阻滞（LBBB；第1组），109例患者没有ST段抬高或LBBB（第2组）。在第1组和第2组中，AMI患者的CAC评分显著高于非AMI患者。第1组中识别AMI的CAC评分最佳截断值为11.5（敏感性80%；特异性71%），第2组为27.4（敏感性80%；特异性76%）。多因素分析显示，CAC评分是AMI最强的预测指标（OR，10.91；95%CI：6.00-25.97）。此外，CAC评分是30天生存率的独立预测指标（OR，0.38；95%CI：0.15-0.95）。评估CAC是识别OHCA幸存者中AMI的一种有用方法，无论复苏后ECG上是否有ST段变化。
