Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA.
Center for Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia.
Catheter Cardiovasc Interv. 2022 Feb;99(3):804-811. doi: 10.1002/ccd.29858. Epub 2021 Jul 8.
Evaluate the differences in coronary artery disease (CAD) burden between patients with ischemic resuscitated, ischemic refractory VT/VF OHCA events and N/STEMI.
Refractory out-of-hospital cardiac arrest patients presenting with initial shockable rhythms (VT/VF OHCA) have the highest mortality among patients with acute cardiac events. No predictors of VT/VF OHCA refractoriness have been identified.
A retrospective cohort design was used to assess baseline characteristics, clinical outcomes, and the angiographic severity of disease among patients with VT/VF OHCA undergoing emergent coronary angiography at the University of Minnesota Medical Center. The Gensini score was calculated for all patients to assess the angiographic burden of CAD. For patients with ischemia-related cardiac arrest, outcomes were further compared to an independent non-OHCA population presenting with N/STEMI.
During the study period, 538 patients were admitted after VT/VF OHCA. Among them, 305 presented with resuscitated, and 233 with refractory VT/VF. 66% of resuscitated and 70% of refractory VT/VF had an underlying, angiographically documented, ischemic etiology. Ischemic resuscitated and refractory VT/VF had significant differences in Gensini score, (80.7 ± 3.6 and 127.6 ± 7.1, respectively, p < 0.001) and survival (77.3% and 30.0%, respectively, p < 0.001). Both groups had a higher CAD burden and worse survival than the non-OHCA N/STEMI population (360 patients). Ischemic refractory VT/VF was significantly more likely to present with chronic total occlusion in comparison to both N/STEMI and ischemic resuscitated VT/VF.
Ischemia-related, refractory VT/VF OHCA has a higher burden of CAD and the presence of CTOs compared to resuscitated VT/VF OHCA and N/STEMI.
评估缺血性再灌注、缺血性难治性 VT/VF 院外心脏骤停事件与 N/STEMI 患者的冠状动脉疾病（CAD）负担差异。
初始可除颤节律（VT/VF OHCA）的难治性院外心脏骤停患者在急性心脏事件患者中死亡率最高。尚未确定 VT/VF OHCA 难治性的预测因素。
使用回顾性队列设计评估明尼苏达大学医学中心接受紧急冠状动脉造影的 VT/VF OHCA 患者的基线特征、临床结局和疾病的血管造影严重程度。对所有患者计算 Gensini 评分以评估 CAD 的血管造影负担。对于与缺血相关的心脏骤停患者，将其结局与独立的非 OHCA 人群中出现的 N/STEMI 进行进一步比较。
在研究期间，538 例 VT/VF OHCA 后患者入院。其中，305 例出现再灌注，233 例出现难治性 VT/VF。再灌注和难治性 VT/VF 中有 66%和 70%分别存在潜在的、血管造影证实的缺血病因。缺血性再灌注和难治性 VT/VF 的 Gensini 评分有显著差异，分别为（80.7±3.6 和 127.6±7.1，p<0.001）和生存率（分别为 77.3%和 30.0%，p<0.001）。与非 OHCA N/STEMI 人群（360 例）相比，这两组的 CAD 负担更高，生存率更差。与 N/STEMI 和缺血性再灌注 VT/VF 相比，缺血性难治性 VT/VF 更有可能出现慢性完全闭塞。
与再灌注 VT/VF OHCA 和 N/STEMI 相比，缺血相关的难治性 VT/VF OHCA 的 CAD 负担更高，并且存在 CTO。
