Comparison of role of early (less than six hours) to later (more than six hours) or no cardiac catheterization after resuscitation from out-of-hospital cardiac arrest.
Comparison of role of early (less than six hours) to later (more than six hours) or no cardiac catheterization after resuscitation from out-of-hospital cardiac arrest.
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院外心脏骤停复苏后早期（少于六小时）与晚期（六小时以上）或不进行心导管插入术的作用比较。
DOI：
10.1016/j.amjcard.2011.09.036
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Kim,Francis
中科院分区：
文献类型：
--
作者：
Strote,JustinA;Maynard,Charles;Olsufka,Michele;Nichol,Graham;Copass,MichaelK;Cobb,LeonardA;Kim,Francis
尽管有复苏的心脏骤停（rSCA）患者接受急性心导管插入术的报道，但这种策略的有效性在很大程度上是未知的。我们假设急性心导管插入术可以提高rSCA患者出院时的生存率。1999年至2002年间，来自华盛顿州西雅图的11家机构的240例因室性心动过速或纤颤而发生院外rSCA的患者进行了回顾性队列研究。将患者分为6小时内急性置管组（≤6小时组，n = 61）和>6小时延迟置管组（>6小时组，n = 179）。我们将生存率的关注导向出院、神经系统状态、呈现心电图（ECG）结果的冠状动脉疾病程度和骤停前症状。倾向评分法用于调整接受急性导管插入术的可能性。急性置管≤6小时组（72%）比急性置管≤6小时组（49%）生存率更高（p=0.001）。≤6小时组有38/61（62%）患者行经皮冠状动脉介入治疗，而≤6小时组有13/170（7%）患者行经皮冠状动脉介入治疗，p<0.0001。两组的神经系统状况相似。急性置管组患者在心脏骤停前出现症状的比例明显较高，复苏后心电图显示st段抬高。年龄、旁观者心肺复苏、日间就诊、经皮冠状动脉介入治疗或卒中史、急性ST段抬高均与接受心导管治疗呈正相关。总之，在这一系列院外心脏骤停的患者中，急性导管插入术（出现后6小时内）与生存率的提高有关。
Despite reports of patients with resuscitated sudden cardiac arrest (rSCA) receiving acute cardiac catheterization, the efficacy of this strategy is largely unknown. We hypothesized that acute cardiac catheterization of patients with rSCA would improve survival to hospital discharge. A retrospective cohort of 240 patients with out-of-hospital rSCA due to ventricular tachycardia or fibrillation was identified from 11 institutions in Seattle, Washington, between 1999 and 2002. Patients were grouped into those receiving acute catheterization within 6 hours (≤ 6 hours group, n = 61) and into those with deferred catheterization at > 6 hours or no catheterization during the index hospitalization (>6 hours group, n = 179). We directed attention to survival to hospital discharge, neurologic status, extent of coronary artery disease presenting electrocardiographic (ECG) findings, and pre-arrest symptoms. Propensity score methods were used to adjust for the likelihood of receiving acute catheterization. Survival was greater in patients who underwent acute catheterization ≤ 6 hours group (72%) vs. >6 hours group (49%) (p=0.001). Percutaneous coronary intervention was performed in 38/61 (62%) of patients in ≤ 6 hours group, and 13/170 (7%) in > 6 hours group, p<0.0001. Neurologic status was similar for both groups. A significantly higher percentage of patients in the acute catheterization group had symptoms prior to cardiac arrest, and had ST-segment elevation on post-resuscitation ECG. Age, bystander cardiopulmonary resuscitation, daytime presentation, history of percutaneous coronary intervention or stroke, and acute ST elevation were all positively associated with receiving cardiac catheterization. In conclusion, in this series of patients who sustained out-of-hospital cardiac arrest, acute catheterization (within 6 hours of presentation) was associated with improved survival.