Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (D.E.H., D.S.K., M. Seth, H.S.G., D.S.).
Covenant Healthcare, Saginaw, MI (M. Sharma).
Circ Cardiovasc Interv. 2024 Oct;17(10):e014189. doi: 10.1161/CIRCINTERVENTIONS.124.014189. Epub 2024 Oct 15.
Coronary artery disease remains the largest contributor to cardiac arrests worldwide; yet, long-term outcomes are often driven by neurological status after resuscitation. We examined the association between pre-percutaneous coronary intervention (PCI) level of consciousness (LOC) and outcomes among patients with cardiac arrest who underwent PCI.
The study cohort included patients undergoing PCI after cardiac arrest between April 2018 and March 2022 at 48 hospitals in the state of Michigan. Pre-PCI LOC was categorized as mentally alert, partially responsive, unresponsive, and unable to assess. In-hospital outcomes included mortality, bleeding, and acute kidney injury.
Among 3021 patients who underwent PCI after cardiac arrest, 1394 (49%) were mentally alert, 132 (5%) were partially responsive, 698 (24%) were unresponsive, and 631 (22%) were unable to assess. The mentally alert cohort had lower mortality (4.59%) compared with the partially responsive (17.42%), unresponsive (50.14%), and unable to assess cohorts (38.03%; <0.001). After adjusting for baseline differences, compared with mentally alert patients, the odds of mortality were markedly elevated in patients who were partially responsive (adjusted odds ratio, 4.63 [95% CI, 2.67-8.04]; <0.001), unable to assess (adjusted odds ratio, 13.95 [95% CI, 9.97-19.51]; <0.001), and unresponsive (adjusted odds ratio, 24.36 [17.34-34.23]; <0.001). After adjustment, patients with impaired LOC also had higher risks of acute kidney injury and bleeding compared with mentally alert patients.
Pre-PCI LOC is a strong predictor of in-hospital outcomes after PCI among cardiac arrest patients. A patient's pre-PCI LOC should be considered an important factor when weighing treatment options, designing clinical trials, and counseling patients and their families regarding prognosis after PCI.
冠心病仍然是全球范围内导致心搏骤停的最大原因；然而，复苏后的神经状态往往决定了长期预后。我们研究了经皮冠状动脉介入治疗（PCI）前意识状态（LOC）与接受 PCI 的心搏骤停患者结局之间的关系。
研究队列纳入了 2018 年 4 月至 2022 年 3 月期间在密歇根州 48 家医院接受 PCI 的心搏骤停患者。PCI 前 LOC 分为神志清楚、部分反应、无反应和无法评估。院内结局包括死亡率、出血和急性肾损伤。
在 3021 例接受 PCI 的心搏骤停患者中，1394 例（49%）神志清楚，132 例（5%）部分反应，698 例（24%）无反应，631 例（22%）无法评估。神志清楚组死亡率（4.59%）低于部分反应组（17.42%）、无反应组（50.14%）和无法评估组（38.03%；<0.001）。调整基线差异后，与神志清楚的患者相比，部分反应（调整后比值比，4.63 [95%CI，2.67-8.04]；<0.001）、无法评估（调整后比值比，13.95 [95%CI，9.97-19.51]；<0.001）和无反应（调整后比值比，24.36 [17.34-34.23]；<0.001）患者的死亡风险明显升高。调整后，LOC 受损的患者与神志清楚的患者相比，发生急性肾损伤和出血的风险也更高。
PCI 前 LOC 是心搏骤停患者 PCI 后院内结局的强有力预测指标。在权衡治疗选择、设计临床试验以及向患者及其家属提供 PCI 后预后咨询时，患者 PCI 前的 LOC 应被视为一个重要因素。
