OUT-OF-HOSPITAL CARDIAC-ARREST - USE OF ELECTROPHYSIOLOGIC TESTING IN THE PREDICTION OF LONG-TERM OUTCOME
OUT-OF-HOSPITAL CARDIAC-ARREST - USE OF ELECTROPHYSIOLOGIC TESTING IN THE PREDICTION OF LONG-TERM OUTCOME
复制标题
DOI：
10.1056/nejm198801073180105
复制
发表时间：
1988-01-07
影响因子：
158.5
通讯作者：
RUSKIN, JN
中科院分区：
文献类型：
--
作者：
WILBER, DJ;GARAN, H;RUSKIN, JN
我们研究了166名院外心脏骤停幸存者的电生理测试在预测长期结果中的作用，这些幸存者与急性心肌梗死无关。基线时131例患者(79%)可诱发室性心律失常，127例患者中91例(72%)可被抗心律失常药物和/或手术抑制。在平均21个月的随访期内，29名患者发生了心脏骤停：91名患者中有11名(12%)的诱发性心律失常被抑制(包括5名停止治疗的患者)，36名患者中有12名(33%)持续存在诱发性心律失常，35名患者中有6名(17%)在最初的电生理研究中无法诱发心律失常。COX生存分析确定以下三个变量是心脏骤停复发的显著独立预测因素：诱导性室性心律失常的持续时间(相对风险为3.97[95%可信区间，1.8~8.75]，P=0.0006)、左心室射血分数小于或等于30%(相对风险为2.6[1.21~5.53]，P=0.0138)、是否进行心脏手术(相对风险为4.2[0.99~17.77]，P=0.0512)。我们的结论是，电生理测试有助于量化院外心脏骤停幸存者随后发生心脏骤停的风险。
We examined the role of electrophysiologic testing in the prediction of long-term outcome in 166 survivors of out-of-hospital cardiac arrest not associated with acute myocardial infarction. Ventricular arrhythmias were inducible in 131 patients (79 percent) at base line and were suppressed by antiarrhythmic drugs or surgery (or both) in 91 of 127 (72 percent). During a median follow-up period of 21 months, cardiac arrest recurred in 29 patients: 11 (12 percent) of the 91 in whom inducible arrhythmias had been suppressed (including 5 patients in whom treatment had been discontinued), 12 (33 percent) of the 36 in whom inducible arrhythmias persisted, and 6 (17 percent) of the 35 in whom arrhythmias could not be induced at the initial electrophysiologic study. Cox survival analysis identified the following three variables as significant independent predictors of recurrent cardiac arrest: persistence of inducible ventricular arrhythmias (relative risk, 3.97 [95 percent confidence interval, 1.80 to 8.75], P = 0.0006), a left ventricular ejection fraction of 30 percent or less (relative risk, 2.60 [1.21 to 5.53], P = 0.0138), and the absence of cardiac surgery (relative risk, 4.20 [0.99 to 17.77], P = 0.0512). We conclude that electrophysiologic testing is useful in quantifying the subsequent risk of cardiac arrest among survivors of out-of-hospital cardiac arrest.