心脏停搏患者行冠状动脉造影和经皮冠状动脉介入术治疗后未恢复自主循环。

Coronary angiography and percutaneous coronary intervention in cardiac arrest patients without return of spontaneous circulation.

机构信息

2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.

出版信息

Resuscitation. 2022 Jun;175:133-141. doi: 10.1016/j.resuscitation.2022.03.027. Epub 2022 Mar 30.

DOI:10.1016/j.resuscitation.2022.03.027

PMID:35367316

Abstract

OBJECTIVES

This study aimed to examine coronary angiography (CAG) findings, percutaneous coronary intervention (PCI) results and outcomes in out-of-hospital cardiac arrest patients (OHCA) without return of spontaneous circulation (ROSC) on admission to hospital.

METHODS

We analyzed the OHCA register and compared CAG, PCI, and outcome data in patients with and without ROSC on admission to hospital.

RESULTS

Between January 2012 and December 2020, 697 OHCA patients were analyzed. Of these, 163 (23%) did not have ROSC at admission. Patients without ROSC were younger (59 vs. 61 years, p = 0.001) and had a longer resuscitation time (62 vs. 18 minutes, p < 0.001) than patients with ROSC. Significant coronary artery disease was highly prevalent in both groups (65% vs. 68%, p = 0.48). Patients without ROSC had higher rates of acute coronary occlusions (42% vs. 33%, p = 0.046), specifically affecting the left main stem (16% vs. 1%, p < 0.001). PCI was performed in 81 patients (50%) without ROSC and in 295 (55%) with ROSC (p = 0.21). The success rate was 86% in patients without ROSC and 90% in patients with ROSC (p = 0.33). Thirty-day survival was 24% in patients without ROSC and 70% in patients with ROSC.

CONCLUSIONS

OHCA patients without ROSC on admission to hospital had higher acute coronary occlusion rates than patients with prehospital ROSC. PCI is feasible with a high success rate in patients without ROSC. Despite prolonged resuscitation times, meaningful survival in patients admitted without ROSC is achievable.

摘要

目的

本研究旨在探讨无自主循环恢复（ROSC）入院的院外心脏骤停（OHCA）患者的冠状动脉造影（CAG）结果、经皮冠状动脉介入治疗（PCI）结果和预后。

方法

我们分析了 OHCA 登记处，并比较了入院时无 ROSC 和有 ROSC 的患者的 CAG、PCI 和结局数据。

结果

2012 年 1 月至 2020 年 12 月，分析了 697 例 OHCA 患者。其中，163 例（23%）入院时无 ROSC。无 ROSC 患者比有 ROSC 患者更年轻（59 岁比 61 岁，p=0.001），复苏时间更长（62 分钟比 18 分钟，p<0.001）。两组均有很高的冠状动脉疾病发生率（65%比 68%，p=0.48）。无 ROSC 患者急性冠状动脉闭塞发生率较高（42%比 33%，p=0.046），特别是左主干（16%比 1%，p<0.001）。81 例（50%）无 ROSC 患者和 295 例（55%）有 ROSC 患者进行了 PCI（p=0.21）。无 ROSC 患者的成功率为 86%，有 ROSC 患者的成功率为 90%（p=0.33）。无 ROSC 患者的 30 天生存率为 24%，有 ROSC 患者的生存率为 70%。