Prehosp Emerg Care. 2022 Nov-Dec;26(6):764-771. doi: 10.1080/10903127.2021.1992054. Epub 2021 Nov 3.
ST-segment elevation myocardial infarction (STEMI) is a common cause of out-of-hospital cardiac arrest (OHCA). For these patients, urgent angiography and revascularization is an important treatment goal. There is a lack of data on the prognosis of STEMI patients after OHCA, who are diagnosed and treated by paramedics prior to hospital transport for primary percutaneous coronary intervention (PCI). Included were adult STEMI patients identified and treated by paramedics in Queensland (Australia) from January 2016 to December 2019, transported to a hospital for primary PCI, and receiving primary PCI. Patients were grouped into those with resuscitated OHCA and those without OHCA. Clinically-important time intervals, angiographic and clinical profiles, and survival were described. Patients with OHCA had longer time intervals from prehospital STEMI identification to reperfusion than those without OHCA (median 97 versus 87 mins, = 0.001). The former had higher rates of cardiac arrhythmia history (50.5 versus 12.4%, < 0.001), classified low left ventricular ejection fraction on admission (64.9 versus 50.1%, = 0.006), and cardiogenic shock (5.2 versus 1.2%, = 0.011) than the latter. A significantly higher proportion of patients with OHCA had multiple diseased vessels (16.9 versus 8.3%, = 0.005). In-hospital, 30-day, and one-year mortality was low, being 4.1%, 4.1% and 5.2%, respectively, for STEMI patients with OHCA. The corresponding figures for those without OHCA were 1.6%, 1.8% and 3.3%, respectively. Survival in paramedic-identified STEMI patients treated with primary PCI following OHCA resuscitation was high. Rapid angiography and reperfusion are critical in these patients.
ST 段抬高型心肌梗死（STEMI）是院外心脏骤停（OHCA）的常见原因。对于这些患者，紧急血管造影和血运重建是一个重要的治疗目标。对于在医院进行初级经皮冠状动脉介入治疗（PCI）前由护理人员诊断和治疗的 OHCA 后 STEMI 患者的预后数据较少。纳入了 2016 年 1 月至 2019 年 12 月期间在澳大利亚昆士兰州由护理人员识别和治疗的成年 STEMI 患者，这些患者被送往医院进行初级 PCI，并接受了初级 PCI。患者分为有 OHCA 复苏的和没有 OHCA 的。描述了临床重要的时间间隔、血管造影和临床特征以及生存率。有 OHCA 的患者从院前 STEMI 识别到再灌注的时间间隔长于没有 OHCA 的患者（中位数为 97 分钟对 87 分钟，=0.001）。前者心律失常史发生率较高（50.5%对 12.4%，<0.001），入院时左心室射血分数较低（64.9%对 50.1%，=0.006）和心源性休克（5.2%对 1.2%，=0.011）的发生率也较高。有 OHCA 的患者中有更多的患者存在多支血管病变（16.9%对 8.3%，=0.005）。OHCA 患者的院内、30 天和 1 年死亡率较低，分别为 4.1%、4.1%和 5.2%。没有 OHCA 的患者分别为 1.6%、1.8%和 3.3%。OHCA 复苏后接受初级 PCI 治疗的护理人员识别的 STEMI 患者的存活率较高。快速血管造影和再灌注对于这些患者至关重要。
