Department of Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands.
Department of General Practice, Amsterdam Public Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.
Open Heart. 2021 Dec;8(2). doi: 10.1136/openhrt-2021-001805.
This study aimed to determine whether patients suffering from out-of-hospital cardiac arrest (OHCA) with a pre-OHCA diagnosis of heart disease have higher survival chances than patients without such a diagnosis and to explore possible underlying mechanisms.
A retrospective cohort study in 3760 OHCA patients from the Netherlands (2010-2016) was performed. Information from emergency medical services, treating hospitals, general practitioner, resuscitation ECGs and civil registry was used to assess medical histories and the presence of pre-OHCA diagnosis of heart disease. We used multivariable regression analysis to calculate associations with survival to hospital admission or discharge, immediate causes of OHCA (acute myocardial infarction (AMI) vs non-AMI) and initial recorded rhythm.
Overall, 48.1% of OHCA patients had pre-OHCA heart disease. These patients had higher odds to survive to hospital admission than patients without pre-OHCA heart disease (OR 1.25 (95%CI 1.05 to 1.47)), despite being older and more often having cardiovascular risk factors and some non-cardiac comorbidities. These patients also had higher odds of shockable initial rhythm (SIR) (OR 1.60 (1. 36 to 1.89)) and a lower odds of AMI as immediate cause of OHCA (OR 0.33 (0.25 to 0.42)). Their chances of survival to hospital discharge were not significantly larger (OR 1.16 (0.95 to 1.42)).
Having pre-OHCA diagnosed heart disease is associated with better odds to survive to hospital admission, but not to hospital discharge. This is associated with higher odds of a SIR and in a subgroup with available diagnosis a lower proportion of AMI as immediate cause of OHCA.
本研究旨在确定患有院外心脏骤停（OHCA）且在 OHCA 前有心脏病诊断的患者是否比没有此类诊断的患者有更高的生存机会，并探讨可能的潜在机制。
对荷兰 3760 名 OHCA 患者（2010-2016 年）进行了回顾性队列研究。利用来自急救医疗服务、治疗医院、全科医生、复苏心电图和民事登记处的信息，评估了病史和 OHCA 前心脏病的诊断情况。我们使用多变量回归分析来计算与住院或出院生存率、OHCA 的即时原因（急性心肌梗死（AMI）与非 AMI）和初始记录节律相关的因素。
总体而言，48.1%的 OHCA 患者有 OHCA 前心脏病。与没有 OHCA 前心脏病的患者相比，这些患者存活至住院的几率更高（OR 1.25（95%CI 1.05 至 1.47）），尽管他们年龄更大，且更常伴有心血管危险因素和一些非心脏合并症。这些患者也有更高的初始可除颤节律（SIR）几率（OR 1.60（1.36 至 1.89）），且 AMI 作为 OHCA 即时原因的几率较低（OR 0.33（0.25 至 0.42））。但他们的住院存活率并没有显著提高（OR 1.16（0.95 至 1.42））。
OHCA 前诊断为心脏病与存活至住院的几率增加相关，但与存活至出院的几率无关。这与 SIR 几率增加相关，在有可用诊断的亚组中，AMI 作为 OHCA 即时原因的比例较低。
