Division of Cardiovascular Medicine, Department of Medicine, Naples Heart Institute, Naples, FL, USA.
Division of Cardiovascular Medicine, Department of Medicine, University of Maryland, Baltimore, MD, USA.
Indian Heart J. 2023 Nov-Dec;75(6):443-450. doi: 10.1016/j.ihj.2023.10.004. Epub 2023 Oct 18.
There are limited data on in-hospital cardiac arrest (IHCA) complicating non-ST-segment-elevation myocardial infarction (NSTEMI) based on management strategy.
We used National Inpatient Sample (2000-2017) to identify adults with NSTEMI (not undergoing coronary artery bypass grafting) and concomitant IHCA. The cohort was stratified based on use of early (hospital day 0) or delayed (≥hospital day 1) coronary angiography (CAG), percutaneous coronary intervention (PCI), and medical management. Outcomes included incidence of IHCA, in-hospital mortality, adverse events, length of stay, and hospitalization costs.
Of 6,583,662 NSTEMI admissions, 375,873 (5.7 %) underwent early CAG, 1,133,143 (17.2 %) received delayed CAG, 2,326,391 (35.3 %) underwent PCI, and 2,748,255 (41.7 %) admissions were managed medically. The medical management cohort was older, predominantly female, and with higher comorbidities. Overall, 63,085 (1.0 %) admissions had IHCA, and incidence of IHCA was highest in the medical management group (1.4 % vs 1.1 % vs 0.7 % vs 0.6 %, p < 0.001) compared to early CAG, delayed CAG and PCI groups, respectively. In adjusted analysis, early CAG (adjusted OR [aOR] 0.67 [95 % confidence interval {CI} 0.65-0.69]; p < 0.001), delayed CAG (aOR 0.49 [95 % CI 0.48-0.50]; p < 0.001), and PCI (aOR 0.42 [95 % CI 0.41-0.43]; p < 0.001) were associated with lower incidence of IHCA compared to medical management. Compared to medical management, early CAG (adjusted OR 0.53, CI: 0.49-0.58), delayed CAG (adjusted OR 0.34, CI: 0.32-0.36) and PCI (adjusted OR 0.19, CI: 0.18-0.20) were associated with lower in-hospital mortality (all p < 0.001).
Early CAG and PCI in NSTEMI was associated with lower incidence of IHCA and lower mortality among NSTEMI-IHCA admissions.
基于管理策略，非 ST 段抬高型心肌梗死（NSTEMI）并发院内心搏骤停（IHCA）的数据有限。
我们使用国家住院患者样本（2000-2017 年）确定患有 NSTEMI（未行冠状动脉旁路移植术）和同时并发 IHCA 的成年人。该队列根据早期（住院日 0 天）或延迟（≥住院日 1 天）行冠状动脉造影（CAG）、经皮冠状动脉介入治疗（PCI）和药物治疗进行分层。结果包括 IHCA 发生率、院内死亡率、不良事件、住院时间和住院费用。
在 6583662 例 NSTEMI 入院患者中，375873 例（5.7%）接受了早期 CAG，1133143 例（17.2%）接受了延迟 CAG，2326391 例（35.3%）接受了 PCI，2748255 例（41.7%）接受了药物治疗。药物治疗组患者年龄较大，主要为女性，合并症更多。总体而言，63085 例（1.0%）入院患者发生 IHCA，药物治疗组 IHCA 的发生率最高（1.4%比 1.1%比 0.7%比 0.6%，p<0.001）。与早期 CAG、延迟 CAG 和 PCI 组相比。在调整分析中，早期 CAG（调整后的 OR [aOR] 0.67 [95%置信区间 {CI} 0.65-0.69]；p<0.001）、延迟 CAG（aOR 0.49 [95%CI 0.48-0.50]；p<0.001）和 PCI（aOR 0.42 [95%CI 0.41-0.43]；p<0.001）与 IHCA 发生率较低相关。与药物治疗相比，早期 CAG（调整后的 OR 0.53，CI：0.49-0.58）、延迟 CAG（调整后的 OR 0.34，CI：0.32-0.36）和 PCI（调整后的 OR 0.19，CI：0.18-0.20）与 IHCA 患者的院内死亡率较低相关（均 p<0.001）。
NSTEMI 中的早期 CAG 和 PCI 与 NSTEMI-IHCA 患者 IHCA 发生率较低和死亡率较低相关。
