Kajana Vilma, Baldi Enrico, Gentile Francesca Romana, Compagnoni Sara, Quilico Federico, Vicini Scajola Luca, Repetto Alessandra, Mandurino-Mirizzi Alessandro, Ferlini Marco, Marinoni Barbara, Ferrario Ormezzano Maurizio, Primi Roberto, Bendotti Sara, Currao Alessia, Savastano Simone
Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy.
Humanitas Mater Domini, 21053 Castellanza, Italy.
J Clin Med. 2022 Aug 29;11(17):5071. doi: 10.3390/jcm11175071.
Background. The survival benefit of complete versus infarct-related artery (IRA)-only revascularization during the index hospitalization in patients resuscitated from an out-of-hospital cardiac arrest (OHCA) with multivessel disease is unknown. Methods. We considered all the OHCA patients prospectively enrolled in the Lombardia Cardiac Arrest Registry (Lombardia CARe) from 1 January 2015 to 1 May 2021 who underwent coronary angiography (CAG) at the Fondazione IRCCS Policlinico San Matteo (Pavia). Patients’ prehospital, angiographical and survival data were reviewed. Results. Out of 239 patients, 119 had a multivessel coronary disease: 69% received IRA-only revascularization, and 31% received a complete revascularization: 8 during the first procedure and 29 in a staged-procedure after a median time of 5 days [IQR 2.5−10.3]. The complete revascularization group showed significantly higher one-year survival with good neurological outcome than the IRA-only group (83.3% vs. 30.4%, p < 0.001). After correcting for cardiac arrest duration, shockable presenting rhythm, peak of Troponin-I, creatinine on admission and the need for circulatory support, complete revascularization was independently associated with the probability of death and poor neurological outcome [HR 0.3 (95%CI 0.1−0.8), p = 0.02]. Conclusions. This observation study shows that complete myocardial revascularization during the index hospitalization improves one-year survival with good neurological outcome in patients resuscitated from an OHCA with multivessel coronary disease.
背景。对于因院外心脏骤停（OHCA）复苏且患有多支血管病变的患者，在首次住院期间进行完全血运重建与仅对梗死相关动脉（IRA）进行血运重建相比，其生存获益尚不清楚。方法。我们纳入了2015年1月1日至2021年5月1日期间前瞻性登记在伦巴第心脏骤停登记处（Lombardia CARe）且在圣马泰奥综合医院（帕维亚）进行冠状动脉造影（CAG）的所有OHCA患者。回顾了患者的院前、血管造影和生存数据。结果。在239例患者中，119例患有多支冠状动脉疾病：69%接受了仅IRA血运重建，31%接受了完全血运重建：8例在首次手术时进行，29例在中位时间为5天[四分位间距2.5 - 10.3]后进行分期手术。完全血运重建组的1年生存率和良好神经功能结局显著高于仅IRA组（83.3%对30.4%，p < 0.001）。在校正心脏骤停持续时间、可电击的初始心律、肌钙蛋白-I峰值、入院时肌酐水平以及循环支持需求后，完全血运重建与死亡概率和不良神经功能结局独立相关[风险比0.3（95%置信区间0.1 - 0.8），p = 0.02]。结论。这项观察性研究表明，对于因OHCA复苏且患有多支冠状动脉疾病的患者，在首次住院期间进行完全心肌血运重建可改善1年生存率并获得良好神经功能结局。
