Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA (E.P.H., K.R., H.C., A.U.-E., S.S.C.).
Department of Emergency Medicine, Oregon Health and Science University, Portland, OR (J.J.).
Circ Arrhythm Electrophysiol. 2022 Dec;15(12):e011018. doi: 10.1161/CIRCEP.122.011018. Epub 2022 Nov 16.
Despite improvements in management following survival from sudden cardiac arrest (SCA) and wide availability of implantable cardioverter defibrillators for secondary prevention, a subgroup of individuals will suffer multiple distinct episodes of SCA. The objective of this study was to characterize and evaluate the burden of recurrent out-of-hospital SCA among survivors of SCA in a single large US community.
SCA cases were prospectively ascertained in the Oregon Sudden Unexpected Death Study. Individuals that experienced recurrent SCA were identified both prospectively and retrospectively.
We ascertained 6649 individuals with SCA (2002-2020) and 924 (14%) survived to hospital discharge. Of these, 88 survivors (10%) experienced recurrent SCA. Of the nonsurvivors (n=5725), 35 had suffered a recurrent SCA. Of the total 123 SCA cases with recurrent SCA, >60% occurred at least 1 year after the initial SCA (median 23 months, range: 6 days to 31 years). SCA occurred despite a secondary prevention implantable cardioverter defibrillator in 22% (n=26). Prevalence of coronary disease (36% versus 25%), hypertension (69% versus 43%), diabetes (44% versus 21%), and chronic kidney disease (35% versus 14%) was significantly higher in recurrent SCA versus single SCA survivors (n=80, =0.01). Among individuals with no secondary prevention implantable cardioverter defibrillators before recurrent SCA, the majority had apparently reversible etiologies identified at initial SCA, with one-quarter undergoing coronary revascularization and over half diagnosed with noncoronary cardiac etiologies.
At least 10% of SCA survivors had recurrent SCA, and a large subgroup suffered their repeat SCA despite treatment for an apparently reversible etiology. A renewed focus on careful assessment of cardiac substrate as well as management of coronary disease, hypertension, diabetes, and chronic kidney disease in SCA survivors could reduce recurrent SCA.
尽管在经历心脏骤停（SCA）后存活的患者的管理得到了改善，并且广泛应用植入式心脏复律除颤器进行二级预防，但仍有一部分患者会经历多次不同的 SCA 发作。本研究的目的是描述和评估在美国单一大型社区中 SCA 幸存者中反复发作的院外 SCA 的特征和负担。
前瞻性地在俄勒冈州突发意外死亡研究中确定 SCA 病例。前瞻性和回顾性地确定经历过复发性 SCA 的患者。
我们确定了 6649 例 SCA 患者（2002-2020 年），其中 924 例（14%）存活至出院。其中，88 例（10%）幸存者经历了复发性 SCA。在非幸存者（n=5725）中，35 例发生了复发性 SCA。在总共 123 例有复发性 SCA 的 SCA 病例中，超过 60%的患者在初次 SCA 后至少 1 年发生 SCA（中位时间为 23 个月，范围：6 天至 31 年）。22%（n=26）的患者在初次 SCA 后发生 SCA 时已使用了二级预防植入式心脏复律除颤器。与单次 SCA 幸存者（n=80，=0.01）相比，复发性 SCA 患者的冠心病（36%比 25%）、高血压（69%比 43%）、糖尿病（44%比 21%）和慢性肾病（35%比 14%）患病率明显更高。在没有复发性 SCA 前使用二级预防植入式心脏复律除颤器的患者中，大多数患者在初次 SCA 时发现了明显可逆转的病因，其中四分之一的患者进行了冠状动脉血运重建，超过一半的患者诊断为非冠状动脉心脏病因。
至少有 10%的 SCA 幸存者发生了复发性 SCA，而且很大一部分患者尽管接受了明显可逆转病因的治疗，但仍再次发生 SCA。对 SCA 幸存者的心脏基质进行更仔细的评估以及对冠心病、高血压、糖尿病和慢性肾病的管理的重视，可能会降低复发性 SCA 的发生。
