Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
BMC Cardiovasc Disord. 2024 Aug 13;24(1):425. doi: 10.1186/s12872-024-04052-1.
In patients resuscitated from cardiac arrest and displaying no ST-segment elevation on initial electrocardiogram (ECG), recent randomized trials indicated no benefits from early coronary angiography. How the results of such randomized studies apply to a real-world clinical context remains to be established.
We retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses.
We analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients.
Our results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation.
在初始心电图（ECG）上无 ST 段抬高的心脏骤停患者中，最近的随机试验表明早期冠状动脉造影无益处。这些随机研究的结果如何适用于真实临床环境仍有待确定。
我们回顾性分析了一个临床数据库，包括自 2017 年 1 月至 2020 年 8 月期间从我们的三级大学医院出院的所有 18 岁或以上的患者，这些患者经历了院外（OHCA）或院内（IHCA）心脏骤停复苏后，立即进行冠状动脉造影，无论初始节律和复苏后 ECG 如何。研究的主要结局是心脏骤停后 90 天的生存率。收集了人口统计学数据、心脏骤停特征、复苏持续时间、入院时的实验室值、血管造影数据和血运重建情况。根据初始 ECG（ST 段抬高或不抬高）进行比较，并在幸存者和非幸存者之间进行比较。使用单变量和多变量回归分析评估与主要结局相关的变量。
我们分析了 147 名患者（130 名 OHCA 和 17 名 IHCA），包括 67 名 ST 段抬高型心肌梗死（STEMI）患者和 80 名非 ST 段抬高型心肌梗死（No STEMI）患者。67 名 STEMI 患者中有 65 名（97%）和 80 名 No STEMI 患者中有 15 名（19%）立即进行了血运重建。STEMI 患者 90 天生存率明显高于 No STEMI 患者（48/67，72%）。在后一组患者中，血运重建状况与生存率无关。在单变量和多变量分析中，年龄较小、可电击节律、无血流和低血流持续时间较短以及初始血乳酸较低与 STEMI 和 No STEMI 患者的生存率相关。相比之下，代谢异常，包括初始血浆钠较低和钾较高，仅与 No STEMI 患者亚组的死亡率显著相关。
我们在真实临床环境中获得的结果表明，在初始 ECG 上无 ST 段抬高的疑似心源性心脏骤停患者中，立即进行冠状动脉造影与生存率无任何关联。此外，我们发现，一些早期代谢异常可能与该人群的死亡率相关，这值得进一步研究。
