院外心脏骤停幸存者中可逆转与不可逆转病因的长期预后比较。
Long-term outcomes among out-of-hospital cardiac arrest survivors with reversible vs. non-reversible causes.
机构信息
Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, BC, Canada.
Department of Cardiology, Herlev Gentofte Hospital, Copenhagen, Denmark.
出版信息
Eur Heart J Acute Cardiovasc Care. 2024 Oct 28;13(10):715-725. doi: 10.1093/ehjacc/zuae097.
AIMS
A reversible cause of out-of-hospital cardiac arrest (OHCA) is vaguely defined in international guidelines as an identifiable transient or potentially correctable condition. However, studies evaluating long-term outcomes of patients experiencing OHCA due to reversible and non-reversible causes are lacking. We aimed to determine differences in long-term outcomes in OHCA survivors according to different aetiology.
METHODS AND RESULTS
From the British Columbia Cardiac Arrest registry, adults with non-traumatic OHCA (2009-2016) surviving to hospital discharge were identified. Patients were categorized by OHCA aetiology combining reversibility and underlying ischaemic aetiology. The primary outcome was a composite of all-cause mortality, recurrent OHCA, or re-hospitalization for sudden cardiac arrest or ventricular arrhythmias. Using the Kaplan-Meier method and multivariable Cox regression models, we compared the risk of the composite outcome according to different OHCA aetiology. Of 1325 OHCA hospital-discharge survivors (median age 62.8 years, 77.9% male), 431 (32.5%) had reversible ischaemic, 415 (31.3%), non-reversible ischaemic, 99 (7.5%), reversible non-ischaemic, and 380 (28.7%), non-reversible non-ischaemic aetiologies. At 3 years post discharge, the Kaplan-Meier event-free rate was highest in patients with a reversible ischaemic aetiology [91%, 95% confidence interval (CI) 87-94%], and lowest in those with a reversible non-ischaemic aetiology (62%, 95% CI 51-72%). In multivariate analyses, compared with non-reversible non-ischaemic cause, reversible ischaemic cause was associated with a significantly lower hazard ratio (HR; 0.52, 95% CI 0.33-0.81), reversible non-ischaemic cause with a significantly higher HR (1.53, 95% CI 1.03-2.32), and non-reversible ischaemic cause with a non-significant HR (0.92, 95% CI 0.64-1.33) for the composite outcome.
CONCLUSION
Compared to other aetiologies, the presence of a reversible ischaemic cause is associated with improved long-term OHCA outcomes.
目的
国际指南将院外心脏骤停（OHCA）的可逆病因定义为可识别的短暂或潜在可纠正的情况。然而，缺乏评估因可逆和不可逆病因导致 OHCA 患者长期结局的研究。我们旨在确定根据不同病因 OHCA 幸存者长期结局的差异。
方法和结果
从不列颠哥伦比亚省心脏骤停登记处中，确定了 2009 年至 2016 年非创伤性 OHCA 并存活至出院的成年人患者。根据可逆性和潜在缺血性病因，将患者的 OHCA 病因进行分类。主要结局是全因死亡率、复发性 OHCA 或因心源性猝死或室性心律失常再次住院的复合结局。使用 Kaplan-Meier 方法和多变量 Cox 回归模型，根据不同的 OHCA 病因比较复合结局的风险。在 1325 例 OHCA 出院幸存者中（中位年龄 62.8 岁，77.9%为男性），431 例（32.5%）有可逆性缺血性病因，415 例（31.3%）为非可逆性缺血性病因，99 例（7.5%）为可逆性非缺血性病因，380 例（28.7%）为非可逆性非缺血性病因。出院后 3 年时，具有可逆性缺血性病因的患者的 Kaplan-Meier 无事件生存率最高[91%，95%置信区间（CI）87-94%]，而具有可逆性非缺血性病因的患者最低（62%，95%CI 51-72%）。在多变量分析中，与非可逆性非缺血性病因相比，可逆性缺血性病因与显著较低的危险比（HR；0.52，95%CI 0.33-0.81）相关，可逆性非缺血性病因与显著较高的 HR（1.53，95%CI 1.03-2.32）相关，而非可逆性缺血性病因与非显著 HR（0.92，95%CI 0.64-1.33）相关。
结论
与其他病因相比，存在可逆性缺血性病因与改善的长期 OHCA 结局相关。
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