University of Arizona Sarver Heart Center, Tucson, AZ, United States; University of Vermont Medical Center, Burlington, VT, United States.
Maine Medical Center, Portland, ME, United States.
Resuscitation. 2021 Oct;167:188-197. doi: 10.1016/j.resuscitation.2021.08.026. Epub 2021 Aug 23.
Out of Hospital Cardiac arrest (OHCA) survivors with ST elevation (STE) with or without shockable rhythms often benefit from coronary angiography (CAG) and, if indicated, percutaneous coronary intervention (PCI). However, the benefits of CAG and PCI in OHCA survivors with nonshockable rhythms (PEA/asystole) and no STE are debated.
Using the International Cardiac Arrest Registry (INTCAR 2.0), representing 44 centers in the US and Europe, comatose OHCA survivors with known presenting rhythms and post resuscitation ECGs were identified. Survival to hospital discharge, neurological recovery on discharge, and impact of CAG with or without PCI on such outcome were assessed and compared with other groups (shockable rhythms with or without STE).
Total of 2113 OHCA survivors were identified and described as; nonshockable/no STE (Nsh-NST) (n = 940, 44.5%), shockable/no STE (Sh-NST) (n = 716, 33.9%), nonshockable/STE (Nsh-ST) (n = 110, 5.2%), and shockable/STE (Sh-ST) (n = 347, 16.4%). Of Nsh-NST, 13.7% (129) were previously healthy before CA and only 17.3% (161) underwent CAG; of those, 30.4% (52) underwent PCI. A total of 18.6% (174) Nsh-NST patients survived to hospital discharge, with 57.5% (100) of such survivors having good neurological recovery (cerebral performance category 1 or 2) on discharge. Coronary angiography was associated with improved odds for survival and neurological recovery among all groups, including those with NSh-NST.
Nonshockable initial rhythms with no ST elevation post resuscitation was the most common presentation after OHCA. Although most of these patients did not undergo coronary angiography, among those who did, 1 in 4 patients had a culprit lesion and underwent revascularization. Invasive CAG should be at least considered for all OHCA survivors, including those with nonshockable rhythms and no ST elevation post resuscitation.
Out of hospital cardiac arrest (OHCA) survivors with ST elevation and/or shockable rhythms benefit from coronary angiography and revascularization. Nonshockable cardiac arrest survivors with no ST elevation have the worst prognosis and rarely undergo coronary angiography. Nonshockable rhythms with no ST elevation was the most common presentation after OHCA and among a small subgroup underwent coronary angiography, 1 in 4 patients with had culprit lesion and underwent revascularization. Coronary angiography was associated with high prevalence of acute culprit coronary lesions and should be considered for those with a probably cardiac cause for their arres.
复苏后 ST 段抬高（STE）伴或不伴可电击节律的院外心脏骤停（OHCA）幸存者通常受益于冠状动脉造影（CAG），如果有指征，还可进行经皮冠状动脉介入治疗（PCI）。然而，在复苏后无电击节律（PEA/心搏停止）且无 STE 的 OHCA 幸存者中，CAG 和 PCI 的益处存在争议。
使用国际心脏骤停登记处（INTCAR 2.0），代表美国和欧洲的 44 个中心，确定已知呈现节律和复苏后心电图的昏迷 OHCA 幸存者。评估并比较存活至出院、出院时神经恢复以及 CAG 加或不加 PCI 对这些结果的影响，并与其他组（有或无 STE 的可电击节律）进行比较。
共确定了 2113 名 OHCA 幸存者，并将其描述为：非电击/无 STE（Nsh-NST）（n=940，44.5%）、电击/无 STE（Sh-NST）（n=716，33.9%）、非电击/STE（Nsh-ST）（n=110，5.2%）和电击/STE（Sh-ST）（n=347，16.4%）。在 Nsh-NST 中，13.7%（129 人）在 CA 前是健康的，只有 17.3%（161 人）接受了 CAG；其中，30.4%（52 人）进行了 PCI。Nsh-NST 患者中有 18.6%（174 人）存活至出院，其中 57.5%（100 人）的幸存者出院时神经恢复良好（脑功能分类 1 或 2）。CAG 与所有组（包括 NSh-NST 组）的存活和神经恢复几率增加相关。
复苏后无 ST 段抬高的非电击初始节律是 OHCA 后最常见的表现。尽管这些患者大多数未接受冠状动脉造影，但在接受该检查的患者中，有 1/4 患者存在罪犯病变并接受了血运重建。侵入性 CAG 至少应考虑用于所有 OHCA 幸存者，包括无电击节律和复苏后无 ST 段抬高的患者。
