ST 段抬高型心肌梗死患者心搏骤停的危险因素：一项回顾性队列研究。
Risk factors for sudden cardiac arrest in patients with ST-segment elevation myocardial infarction: a retrospective cohort study.
机构信息
School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404, Taiwan.
Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404, Taiwan.
出版信息
BMC Emerg Med. 2022 Oct 24;22(1):169. doi: 10.1186/s12873-022-00732-3.
BACKGROUND
Sudden cardiac arrest (SCA) is a critical complication of acute myocardial infarction, especially ST-segment elevation myocardial infarction (STEMI). This study identified the risk factors for SCA in patients with STEMI before receiving catheterization.
METHODS
We retrospectively analyzed the data of patients with STEMI and cardiac arrest who presented to a tertiary care center in Taiwan between January 1, 2016, and December 31, 2019. Only patients with coronary artery disease (CAD) confirmed by coronary angiography were included in this study. We collected the patients' demographic and clinical data, such as age, sex, medical history, estimated glomerular filtration rate (eGFR), and coronary angiographic findings. The primary outcome of this study was SCA in patients with STEMI. Continuous and nominal variables were compared using the two-sample Student's t-test and chi-squared test, respectively. The results of logistic regression were subjected to multivariate analysis with adjustment for possible confounders.
RESULTS
A total of 920 patients with STEMI and coronary angiography-documented CAD and 108 patients with SCA who presented between January 1, 2016, and December 31, 2019, were included. The bivariate logistic regression analysis of patients' demographic data revealed that patients with STEMI and SCA were slightly younger, were more likely to have diabetes mellitus, and had a lower eGFR than did the patients without SCA. The coronary angiographic findings indicated a higher prevalence of left main CAD and three-vessel disease in patients with SCA than in patients without SCA. Multivariate logistic regression revealed that left main CAD (odds ratio [OR]: 3.77; 95% confidence interval [CI], 1.84 to 7.72), a lower eGFR (OR: 0.97; 95% CI, 0.96 to 0.98), and younger age (OR: 0.98; 95% CI, 0.96 to 0.99) were the risk factors for SCA in patients with STEMI.
CONCLUSIONS
Left main CAD, lower eGFR, and younger age are the risk factors for cardiac arrest in patients with acute myocardial infarction.
背景
心脏骤停（SCA）是急性心肌梗死（尤其是 ST 段抬高型心肌梗死（STEMI））的严重并发症。本研究旨在确定接受导管插入术之前 STEMI 患者发生 SCA 的危险因素。
方法
我们回顾性分析了 2016 年 1 月 1 日至 2019 年 12 月 31 日期间在台湾一家三级保健中心就诊的 STEMI 合并心脏骤停患者的数据。本研究仅纳入经冠状动脉造影证实为冠心病（CAD）的患者。我们收集了患者的人口统计学和临床数据，如年龄、性别、病史、估算肾小球滤过率（eGFR）和冠状动脉造影结果。本研究的主要结局是 STEMI 患者发生 SCA。连续变量和分类变量分别采用两样本 t 检验和卡方检验进行比较。使用多变量逻辑回归分析对可能的混杂因素进行调整。
结果
共纳入 920 例 STEMI 患者和冠状动脉造影证实的 CAD 患者和 108 例 2016 年 1 月 1 日至 2019 年 12 月 31 日期间出现 SCA 的患者。对患者人口统计学数据的双变量逻辑回归分析显示，STEMI 合并 SCA 患者的年龄稍小，更可能患有糖尿病，且 eGFR 较低。冠状动脉造影结果显示，SCA 患者的左主干 CAD 和三支血管病变的发生率高于非 SCA 患者。多变量逻辑回归显示，左主干 CAD（比值比 [OR]：3.77；95%置信区间 [CI]：1.84 至 7.72）、较低的 eGFR（OR：0.97；95% CI：0.96 至 0.98）和较小的年龄（OR：0.98；95% CI：0.96 至 0.99）是 STEMI 患者发生 SCA 的危险因素。
结论
左主干 CAD、较低的 eGFR 和较小的年龄是急性心肌梗死患者发生心脏骤停的危险因素。
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