Department of Cardiology and Angiology, Medizinische Hochschule Hannover, Hannover, Germany.
PLoS One. 2021 May 4;16(5):e0251178. doi: 10.1371/journal.pone.0251178. eCollection 2021.
Myocardial infarction is the most frequent cause for out-of-hospital cardiac arrest (OHCA) in adults. Patients with ST-segment elevations (STE) following return of spontaneous circulation (ROSC) are regularly admitted to the catheterisation laboratory for urgent coronary angiography. Whether patients without obvious STE (NSTE) should receive coronary angiography as part of a standardised diagnostic work-up following OHCA is still debated.
We analysed a cohort of 517 subsequent OHCA patients admitted at our institution who received a standardised diagnostic work-up including coronary angiography and therapeutic hypothermia. Patients were 63±14 years old, 76% were male. Overall, 180 (35%) had ST-elevation in the post-ROSC ECG, 317 (61%) had shockable rhythm (ventricular fibrillation or tachycardia) at first ECG. ROSC was achieved after 26±21 minutes.
Critical coronary stenosis requiring PCI was present in 83% of shockable and 87% of non-shockable STE-OHCA and in 48% of shockable and 22% of non-shockable NSTE-OHCA patients. In-hospital survival was 61% in shockable and 55% in non-shockable STE-OHCA and 60% in shockable and 28% in non-shockable NSTE-OHCA.
Standardised admission diagnostics in OHCA patients undergoing therapeutic hypothermia with a strict admission protocol incorporating ECG and coronary catheterisation shows a high rate of relevant coronary stenosis in STE-OHCA irrespective of the initial rhythm and in NSTE-OHCA with initial shockable rhythm. Based on the unfavourable outcome and low PCI rate observed in NSTE-OHCA patients with a primary non-shockable ECG rhythm it might be reasonable to restrict routine early coronary angiography to patients with primary shockable rhythms and/or ST-segment elevations after ROSC.
心肌梗死是成人院外心脏骤停（OHCA）最常见的原因。在自主循环恢复（ROSC）后出现 ST 段抬高（STE）的患者通常会被送入导管室进行紧急冠状动脉造影。对于没有明显 STE（NSTE）的患者，在 OHCA 后是否应进行冠状动脉造影作为标准化诊断检查的一部分仍存在争议。
我们分析了我院收治的 517 例 OHCA 患者的队列，这些患者接受了标准化的诊断检查，包括冠状动脉造影和治疗性低温。患者年龄为 63±14 岁，76%为男性。总体而言，180 例（35%）在 ROSC 后心电图上有 ST 段抬高，317 例（61%）在首次心电图上有心律骤停（室颤或心动过速）。ROSC 在 26±21 分钟后实现。
需要 PCI 的临界冠状动脉狭窄在有休克表现的 STE-OHCA 患者中占 83%，在非休克表现的 STE-OHCA 患者中占 87%，在有休克表现的 NSTE-OHCA 患者中占 48%，在非休克表现的 NSTE-OHCA 患者中占 22%。有休克表现的 STE-OHCA 患者的院内存活率为 61%，非休克表现的 STE-OHCA 患者为 55%，有休克表现的 NSTE-OHCA 患者为 60%，非休克表现的 NSTE-OHCA 患者为 28%。
在接受治疗性低温的 OHCA 患者中，采用严格的纳入标准，纳入心电图和冠状动脉导管插入术的标准化入院诊断显示，STE-OHCA 患者无论初始节律如何，以及初始为有休克表现的 NSTE-OHCA 患者，均存在较高的相关冠状动脉狭窄率。基于观察到的 NSTE-OHCA 患者不良预后和低 PCI 率，对于初始心电图为无休克表现的原发性 NSTE-OHCA 患者，可能需要合理限制常规早期冠状动脉造影仅限于初始具有休克表现的节律和/或 ROSC 后出现 STE 段抬高的患者。
