ST段抬高型心肌梗死患者经皮冠状动脉介入治疗前的心搏骤停：发生率、预测因素及相关结局
Pre-percutaneous coronary intervention sudden cardiac arrest in ST-elevation myocardial infarction: Incidence, predictors, and related outcomes.
作者信息
Machado Guilherme Pinheiro, Theobald Andre Luiz, de Araujo Gustavo Neves, da Silveira Anderson Donelli, Wainstein Rodrigo Vugman, Fracasso Julia Fagundes, Niches Matheus, Chies Angelo, Goncalves Sandro Cadaval, Pimentel Mauricio, Wainstein Marco Vugman
机构信息
Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
出版信息
Front Cardiovasc Med. 2023 Feb 16;10:1100187. doi: 10.3389/fcvm.2023.1100187. eCollection 2023.
BACKGROUND
ST-segment elevation myocardial infarction (STEMI) is a frequent cause of sudden cardiac arrest (SCA) and early percutaneous coronary intervention (PCI) is associated with increased survival. Despite constant improvements in SCA management, survival remains poor. We aimed to assess pre-PCI SCA incidence and related outcomes in patients admitted with STEMI.
METHODS
This was a prospective cohort study of patients admitted with STEMI in a tertiary university hospital over 11 years. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and adverse outcomes were assessed. The primary outcome was in-hospital mortality. The secondary outcome was 1-year mortality after hospital discharge. Predictors of pre-PCI SCA was also assessed.
RESULTS
During the study period 1,493 patients were included; the mean age was 61.1 years (±12), and 65.3% were male. Pre-PCI SCA was present in 133 (8.9%) patients. In-hospital mortality was higher in the pre-PCI SCA group (36.8% vs. 8.8%, < 0.0001). In multivariate analysis, anterior MI, cardiogenic shock, age, pre-PCI SCA and lower ejection fraction remained significantly associated with in-hospital mortality. When we analyzed the interaction between pre-PCI SCA and cardiogenic shock upon admission there is a further increase in mortality risk when both conditions are present. For predictors of pre-PCI SCA, only younger age and cardiogenic shock remained significantly associated after multivariate analysis. Overall 1-year mortality rates were similar between pre-PCI SCA survivors and non-pre-PCI SCA group.
CONCLUSION
In a cohort of consecutive patients admitted with STEMI, pre-PCI SCA was associated with higher in-hospital mortality, and its association with cardiogenic shock further increases mortality risk. However, long-term mortality among pre-PCI SCA survivors was similar to non-SCA patients. Understanding characteristics associated with pre-PCI SCA may help to prevent and improve the management of STEMI patients.
背景
ST段抬高型心肌梗死（STEMI）是心脏骤停（SCA）的常见原因，早期经皮冠状动脉介入治疗（PCI）与生存率提高相关。尽管SCA管理不断改进，但生存率仍然很低。我们旨在评估STEMI入院患者PCI前SCA的发生率及相关结局。
方法
这是一项对一所三级大学医院11年间收治的STEMI患者进行的前瞻性队列研究。所有患者均接受急诊冠状动脉造影。评估基线特征、手术细节、再灌注策略和不良结局。主要结局是院内死亡率。次要结局是出院后1年死亡率。还评估了PCI前SCA的预测因素。
结果
在研究期间，纳入了1493例患者；平均年龄为61.1岁（±12岁），男性占65.3%。133例（8.9%）患者发生了PCI前SCA。PCI前SCA组的院内死亡率更高（36.8%对8.8%，P<0.0001）。在多变量分析中，前壁心肌梗死、心源性休克、年龄、PCI前SCA和较低的射血分数仍然与院内死亡率显著相关。当我们分析入院时PCI前SCA与心源性休克之间的相互作用时，两种情况同时存在时死亡风险进一步增加。对于PCI前SCA的预测因素，多变量分析后只有较年轻的年龄和心源性休克仍然显著相关。PCI前SCA幸存者和非PCI前SCA组的总体1年死亡率相似。
结论
在一组连续收治的STEMI患者中，PCI前SCA与较高的院内死亡率相关，其与心源性休克的关联进一步增加了死亡风险。然而，PCI前SCA幸存者的长期死亡率与非SCA患者相似。了解与PCI前SCA相关的特征可能有助于预防和改善STEMI患者的管理。
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