冠状动脉造影与难治性心室颤动患者的 ST 段抬高和无 ST 段抬高的关联 - 难治性心室颤动的双序贯体外除颤（DOSE-VF 随机对照试验）的子研究。

Association of coronary angiography with ST-elevation and no ST-elevation in patients with refractory ventricular fibrillation - A substudy of the DOuble SEquential External Defibrillation for Refractory Ventricular Fibrillation (DOSE-VF randomized control trial).

机构信息

Department of Emergency Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Toronto, Canada.

Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Sunnybrook Centre for Prehospital Medicine, Toronto, Canada.

出版信息

Resuscitation. 2024 May;198:110163. doi: 10.1016/j.resuscitation.2024.110163. Epub 2024 Mar 4.

DOI:10.1016/j.resuscitation.2024.110163

PMID:38447909

Abstract

BACKGROUND

Refractory ventricular fibrillation or pulseless ventricular tachycardia (rVF/pVT) during out-of-hospital cardiac arrest (OHCA) is associated with poor survival. Double sequential defibrillation (DSED) and vector change (VC) improved survival for rVF/pVT in the DOSE-VF RCT. However, the role of angiography and percutaneous coronary intervention (angiography/PCI) during the trial is unknown.

OBJECTIVES

To determine the incidence of ST-elevation (STE) and no ST-elevation (NO-STE) on post-arrest ECG and the use of angiography/PCI in patients with rVF/pVT during the DOSE-VF RCT.

METHOD

Adults (≥18-years) with rVF/pVT OHCA randomized in the DOSE-VF RCT who survived to hospital admission were included. The primary analysis compared the proportion of angiography in STE and NO-STE. We performed regression modelling to examine association between STE, the interaction with defibrillation strategy, and survival to discharge controlling for known covariates.

RESULTS

We included 151 patients, 74 (49%) with STE and 77 (51%) with NO-STE. The proportion of angiography was higher in the STE cohort than NO-STE (87.8% vs 44.2%, p < 0.001); similarly the proportion of PCI was also higher (75.7% vs 9.1%, p < 0.001). Survival to discharge was similar between STE and NO-STE (63.5% vs 51.9%, p = 0.15). Use of angiography/PCI did not differ between defibrillation strategies. Decreased age (OR 0.95, 95% CI 0.92-0.98; p = 0.001) and angiography (OR 9.33, 95% CI 3.60-26.94; p < 0.001) were predictors of survival; however, STE was not.

CONCLUSION

We found high rates of angiography/PCI in patients with STE compared to NO-STE, however similar rates of survival. Angiography was an independent predictor of survival. Improved rates of survival employing DSED and VC were independent of angiography/PCI.

摘要

背景

院外心脏骤停（OHCA）期间出现难治性心室颤动或无脉性室性心动过速（rVF/pVT）与存活率差相关。在 DOSE-VF RCT 中，双序除颤（DSED）和向量变换（VC）提高了 rVF/pVT 的存活率。然而，试验期间的血管造影和经皮冠状动脉介入治疗（angiography/PCI）的作用尚不清楚。

目的

确定复苏后心电图上 ST 段抬高（STE）和非 ST 段抬高（NO-STE）的发生率，并确定 DOSE-VF RCT 中 rVF/pVT 患者的血管造影/PCI 的使用情况。

方法

纳入在 DOSE-VF RCT 中存活至入院的 rVF/pVT OHCA 成人患者。主要分析比较 STE 和 NO-STE 患者的血管造影比例。我们进行回归建模，以检查 STE 与除颤策略之间的关联，以及控制已知协变量后出院存活率。

结果

我们纳入了 151 名患者，其中 74 名（49%）为 STE，77 名（51%）为 NO-STE。STE 组的血管造影比例高于 NO-STE 组（87.8% vs 44.2%，p<0.001）；同样，PCI 的比例也更高（75.7% vs 9.1%，p<0.001）。出院存活率在 STE 和 NO-STE 之间相似（63.5% vs 51.9%，p=0.15）。两种除颤策略之间的血管造影/PCI 使用无差异。年龄降低（OR 0.95，95%CI 0.92-0.98；p=0.001）和血管造影（OR 9.33，95%CI 3.60-26.94；p<0.001）是存活率的预测因素；然而，STE 不是。