Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sci Rep. 2022 Mar 14;12(1):4354. doi: 10.1038/s41598-022-08383-x.
This study aimed to evaluate the prevalence of left main or triple vessel coronary artery disease (CAD) in comatose out-of-hospital cardiac arrest (OHCA) survivors and assessed their outcome based on the revascularization strategy. This multicenter, retrospective, observational registry-based study was conducted at 9 Korean tertiary care hospitals. Adult comatose OHCA survivors with left main or triple vessel CAD documented by immediate (≤ 2 h) coronary angiography after return of spontaneous circulation between 2011 and 2019 were included. The primary outcome was neurologically intact survival at 1-month. Among 727 OHCA patients, 150 (25%) had left main or triple vessel CAD and underwent complete (N = 32), incomplete (N = 78), and no immediate (N = 40) revascularization, respectively. The rate of neurologically intact survival at 1 month was significantly different among the groups (53%, 32%, and 23% for complete, incomplete, and no immediate revascularization groups, respectively; P = 0.02). After adjustment using the inverse probability of treatment weighting, complete revascularization was associated with neurologically intact survival at 1 month (odds ratio, 2.635; P = 0.01). Left main or triple vessel CAD is not uncommon in OHCA patients. The complete revascularization was associated with better outcome. Further clinical trials to confirm the best revascularization strategy are needed.
本研究旨在评估昏迷性院外心脏骤停（OHCA）幸存者中左主干或三支血管冠状动脉疾病（CAD）的患病率，并根据再血管化策略评估其结局。这项多中心、回顾性、基于观察性登记的研究在韩国 9 家三级保健医院进行。纳入 2011 年至 2019 年期间在自主循环恢复后立即（≤2 小时）行冠状动脉造影确诊为左主干或三支血管 CAD 的昏迷性 OHCA 幸存者。主要结局为 1 个月时神经功能完整存活。在 727 例 OHCA 患者中，150 例（25%）存在左主干或三支血管 CAD，并分别接受了完全（N=32）、不完全（N=78）和无即刻（N=40）血运重建。1 个月时神经功能完整存活的比例在各组间有显著差异（完全、不完全和无即刻血运重建组分别为 53%、32%和 23%；P=0.02）。使用逆概率治疗加权调整后，完全血运重建与 1 个月时的神经功能完整存活相关（比值比，2.635；P=0.01）。左主干或三支血管 CAD 在 OHCA 患者中并不少见。完全血运重建与更好的结局相关。需要进一步的临床试验来证实最佳的血运重建策略。
