Nadhir Sadek, Björkenstam Marie, Bobbio Emanuele, Eken Berkan, Ljungman Charlotta, Polte Christian, Rawshani Araz, Bollano Entela
Institute of Medicine Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden.
Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden.
J Am Heart Assoc. 2024 Dec 3;13(23):e035763. doi: 10.1161/JAHA.124.035763. Epub 2024 Nov 29.
Acute myocarditis/perimyocarditis presents with a variable prognosis ranging from complete recovery to end-stage heart failure (HF), sudden cardiac arrest, and death. The relationship between a prior history of myocarditis/perimyocarditis and outcomes in out-of-hospital cardiac arrest remains unclear.
Using the SCRR (Swedish Cardiopulmonary Resuscitation Registry), we analyzed 54 568 cases of out-of-hospital cardiac arrest from 2010 to 2020 where cardiopulmonary resuscitation was attempted. Patients with a history of myocarditis/perimyocarditis were compared with those without in terms of characteristics and survival. Four hundred ninety-eight patients (0.9%) had a history of myocarditis/perimyocarditis. These patients were predominantly men (73.8%), had an average age of 68 years, displayed a higher prevalence of cardiovascular comorbidities, and more frequently displayed shockable initial rhythms (28.7% versus 23.1%). Prior myocarditis/pericarditis did not correlate with worse short-term (odds ratio [OR], 0.91 [95% CI, 0.61-1.33]) or long-term survival (hazard ratio [HR], 1.01 [95% CI, 0.91-1.13]). Patients with myocarditis/perimyocarditis with concomitant HF showed worse long-term survival in unadjusted analyses. Adjusted analyses confirmed that absence of HF was linked to improved short-term survival (OR, 1.46 [95% CI, 1.32-1.62]), whereas prevalence of HF was a predictor for worsened long-term survival (HR, 0.91 [95% CI, 0.91-0.95]) after out-of-hospital cardiac arrest. Analyses were adjusted for myocarditis/perimyocarditis, sex, age, HF, time to cardiopulmonary resuscitation start, and initial rhythm.
Prior myocarditis/perimyocarditis per se did not contribute to a worsened outcome following out-of-hospital cardiac arrest. However, the presence of concomitant HF was linked to unfavorable short- and long-term outcomes.
急性心肌炎/心包心肌炎的预后各不相同，从完全康复到终末期心力衰竭（HF）、心搏骤停和死亡。心肌炎/心包心肌炎既往史与院外心搏骤停结局之间的关系尚不清楚。
利用瑞典心肺复苏注册中心（SCRR）的数据，我们分析了2010年至2020年期间54568例尝试进行心肺复苏的院外心搏骤停病例。比较了有心肌炎/心包心肌炎病史的患者与无该病史患者的特征及生存情况。498例患者（0.9%）有心肌炎/心包心肌炎病史。这些患者以男性为主（73.8%），平均年龄68岁，心血管合并症患病率较高，且更常出现可电击心律（28.7%对23.1%）。既往心肌炎/心包炎与短期（优势比[OR]，0.91[95%置信区间，0.61 - 1.33]）或长期生存情况较差无关（风险比[HR]，1.01[95%置信区间，0.91 - 1.13]）。在未调整分析中，合并HF的心肌炎/心包心肌炎患者长期生存情况较差。调整分析证实，无HF与短期生存改善相关（OR，1.46[95%置信区间，1.32 - 1.62]），而院外心搏骤停后HF的患病率是长期生存恶化的一个预测因素（HR，0.91[95%置信区间，0.91 - 0.95]）。分析对心肌炎/心包心肌炎、性别、年龄、HF、开始心肺复苏的时间和初始心律进行了校正。
既往心肌炎/心包心肌炎本身并不会导致院外心搏骤停后结局恶化。然而，合并HF与不良的短期和长期结局相关。
