Olanipekun Titilope, Abe Temidayo, Igwe Joseph, Effoe Valery, Egbuche Obiorah, Chris-Olaiya Abimbola, Snyder Richard
Department of Hospital Medicine, Covenant Health System, Knoxville, TN, USA; Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA; Safety, Quality, Informatics and Leadership Program, Department of Postgraduate Education, Harvard Medical School, Boston, MA, USA.
Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
Cardiovasc Revasc Med. 2022 Jul;40S:332-336. doi: 10.1016/j.carrev.2021.11.019. Epub 2021 Nov 20.
The timing of sudden cardiac arrest (SCA) after myocardial infarction (MI) has been a subject of research because of the impact on preventive strategies. Currently, there is limited data on the risk of SCA in the immediate post revascularization period (≤48 h) in non-ST segment elevation myocardial infarction (NSTEMI).
We retrospectively reviewed the electronic medical record system and identified patients who underwent revascularization for NSTEMI at Grady Memorial Hospital, Atlanta, Georgia between January 1st, 2014-December 31st, 2019. We selected patients who had SCA within 48 h of revascularization and evaluated their socio-demographic and inpatient characteristics and outcomes.
Sixteen (16) cases of SCA in the immediate post revascularization period (within 48 h) were identified and analyzed which corresponds to an incidence rate of 1.8% (n = 16/869). The mean age (SD) was 69 years (14.6) and 75% were males. On angiography, more than 80% of the patients had hemodynamically significant lesions in the left anterior descending arteries and its territories and 50% had multivessel disease. All 16 patients had at least one coronary artery with hemodynamically significant lesion and successfully underwent revascularization. Three-quarter of the patients had a shockable rhythm. The etiology of SCA was in-stent thrombosis in 25% of the patients, cardiogenic shock in 19%, acute respiratory failure in 13% and unknown in 44% of the cases. The 30-day mortality rate was 38%.
The rate of SCA is high in the first 48 h after MI even with revascularization. Risk stratification for SCA during this critical period may improve outcomes.
由于对预防策略的影响，心肌梗死（MI）后心脏骤停（SCA）的发生时间一直是研究的课题。目前，关于非ST段抬高型心肌梗死（NSTEMI）患者在血管重建术后即刻（≤48小时）发生SCA的风险的数据有限。
我们回顾性分析了电子病历系统，确定了2014年1月1日至2019年12月31日期间在佐治亚州亚特兰大市格雷迪纪念医院因NSTEMI接受血管重建术的患者。我们选择了在血管重建术后48小时内发生SCA的患者，并评估了他们的社会人口统计学和住院特征及结局。
确定并分析了16例血管重建术后即刻（48小时内）发生SCA的病例，发病率为1.8%（n = 16/869）。平均年龄（标准差）为69岁（14.6），75%为男性。血管造影显示，超过80%的患者在左前降支及其分支有血流动力学显著病变，50%有多支血管病变。所有16例患者至少有一支冠状动脉有血流动力学显著病变，并成功接受了血管重建术。四分之三的患者有可电击心律。SCA的病因在25%的患者中为支架内血栓形成，19%为心源性休克，13%为急性呼吸衰竭，44%的病例病因不明。30天死亡率为38%。
即使进行了血管重建，MI后最初48小时内SCA的发生率仍很高。在此关键时期对SCA进行风险分层可能会改善结局。
