Ando Hirohiko, Sawano Mitsuaki, Kohsaka Shun, Ishii Hideki, Tajima Atomu, Suzuki Wataru, Kunimura Ayako, Nakano Yusuke, Kozuma Ken, Amano Tetsuya
Department of Cardiology, Aichi Medical University, Nagakute, Japan.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, CT, USA.
Resusc Plus. 2024 May 3;18:100647. doi: 10.1016/j.resplu.2024.100647. eCollection 2024 Jun.
Cardiac arrest is a serious complication of acute myocardial infarction. The implementation of contemporary approaches to acute myocardial infarction management, including urgent revascularization procedures, has led to significant improvements in short-term outcomes. However, the extent of post-discharge mortality in patients experiencing cardiac arrest during acute myocardial infarction remains uncertain. This study aimed to determine the post-discharge outcomes of patients with cardiac arrest.
We analysed data from the J-PCI OUTCOME registry, a Japanese prospectively planed, observational, multicentre, national registry of percutaneous coronary intervention involving consecutive patients from 172 institutions who underwent percutaneous coronary intervention and were discharged. Patients who underwent percutaneous coronary intervention for acute myocardial infarction between January 2017 and December 2018 and survived for 30 days were included. Mortality in patients with and without cardiac arrest from 30 days to 1 year after percutaneous coronary intervention for acute myocardial infarction was compared.
Of the 26,909 patients who survived for 30 days after percutaneous coronary intervention for acute myocardial infarction, 1,567 (5.8%) had cardiac arrest at the onset of acute myocardial infarction. Patients with cardiac arrest were younger and more likely to be males than patients without cardiac arrest. The 1-year all-cause mortality was significantly higher in patients with cardiac arrest than in those without (11.9% vs. 2.8%, < 0.001) for all age groups. Multivariable analysis showed that cardiac arrest was an independent predictor of all-cause long-term mortality (hazard ratio: 2.94; 95% confidence interval: 2.29-3.76).
Patients with acute myocardial infarction and concomitant cardiac arrest have a worse prognosis for up to 1 year after percutaneous coronary intervention than patients without cardiac arrest.
心脏骤停是急性心肌梗死的一种严重并发症。包括紧急血运重建手术在内的当代急性心肌梗死管理方法的实施，已使短期预后有了显著改善。然而，急性心肌梗死期间发生心脏骤停的患者出院后死亡率的程度仍不确定。本研究旨在确定心脏骤停患者出院后的预后情况。
我们分析了J-PCI OUTCOME注册研究的数据，这是一项日本前瞻性规划的观察性多中心全国注册研究，涉及来自172个机构的连续接受经皮冠状动脉介入治疗并出院的患者。纳入2017年1月至2018年12月期间因急性心肌梗死接受经皮冠状动脉介入治疗且存活30天的患者。比较急性心肌梗死经皮冠状动脉介入治疗后30天至1年有和无心脏骤停患者的死亡率。
在急性心肌梗死经皮冠状动脉介入治疗后存活30天的26909例患者中，1567例（5.8%）在急性心肌梗死发作时发生了心脏骤停。与无心脏骤停的患者相比，发生心脏骤停的患者更年轻，男性比例更高。所有年龄组中，发生心脏骤停的患者1年全因死亡率显著高于无心脏骤停的患者（11.9%对2.8%，<0.001）。多变量分析显示，心脏骤停是全因长期死亡率的独立预测因素（风险比：2.94；95%置信区间：2.29 - 3.76）。
与无心脏骤停的患者相比，急性心肌梗死合并心脏骤停的患者在经皮冠状动脉介入治疗后长达1年的预后更差。
