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无ST段抬高患者心脏停搏后的冠状动脉造影
Coronary Angiography after Cardiac Arrest without ST-Segment Elevation


Jorrit S. Lemkes ... 心脑血管疾病 • 2019.04.11
相关阅读
• 无STEMI且无可电击复律心律的患者在心脏停搏后的早期心导管检查 • 院外心脏停搏后旁观者施救与患者的1年结局研究 • 更新版心脏停搏患者的抗心律失常药用药指南

摘要


背景

缺血性心脏病是院外心脏停搏的主要原因。对于未患ST段抬高型心肌梗死(STEMI)且心脏停搏后被成功复苏的患者,即刻冠状动脉造影和经皮冠状动脉介入(PCI)在治疗中的作用尚未明确。

 

方法

在这项多中心试验中,我们将552例无STEMI指征的心脏停搏患者随机分组,分别接受即刻冠状动脉造影或延迟至神经功能恢复之后的冠状动脉造影。有适应证的患者均接受了PCI治疗。主要终点是90日时存活。次要终点包括脑功能良好或有轻至中度失能的情况下90日时存活、心肌损伤、儿茶酚胺类药物支持的持续时间、休克指标、室性心动过速复发、机械通气的持续时间、大出血、发生急性肾损伤、需要肾脏替代治疗、达到目标体温所需的时间以及离开重症监护病房时的神经系统状况。

 

结果

90日时,即刻造影组273例患者中的176例(64.5%)和延迟造影组265例患者中的178例(67.2%)存活(比值比,0.89;95%置信区间[CI],0.62~1.27;P=0.51)。即刻造影组和延迟造影组患者达到目标体温所需的中位时间分别为5.4小时和4.7小时(几何平均值之比,1.19;95% CI,1.04~1.36)。其他次要终点无显著组间差异。

 

结论

在无STEMI指征且院外心脏停搏后被成功复苏的患者中,在90日时的总生存率方面,即刻造影策略未优于延迟造影策略(由荷兰心脏研究所[Netherlands Heart Institute]等资助;COACT在Netherlands Trial Register注册号为NTR4973)。





作者信息

Jorrit S. Lemkes, M.D., Gladys N. Janssens, M.D., Nina W. van der Hoeven, M.D., Lucia S.D. Jewbali, M.D., Eric A. Dubois, M.D., Ph.D., Martijn Meuwissen, M.D., Ph.D., Tom A. Rijpstra, M.D., Hans A. Bosker, M.D., Ph.D., Michiel J. Blans, M.D., Ph.D., Gabe B. Bleeker, M.D., Ph.D., Rémon Baak, M.D., Georgios J. Vlachojannis, M.D., Ph.D., Bob J.W. Eikemans, M.D., Pim van der Harst, M.D., Ph.D., Iwan C.C. van der Horst, M.D., Ph.D., Michiel Voskuil, M.D., Ph.D., Joris J. van der Heijden, M.D., Albertus Beishuizen, M.D., Ph.D., Martin Stoel, M.D., Ph.D., Cyril Camaro, M.D., Ph.D., Hans van der Hoeven, M.D., Ph.D., José P. Henriques, M.D., Ph.D., Alexander P.J. Vlaar, M.D., Ph.D., Maarten A. Vink, M.D., Ph.D., Bas van den Bogaard, M.D., Ph.D., Ton A.C.M. Heestermans, M.D., Ph.D., Wouter de Ruijter, M.D., Ph.D., Thijs S.R. Delnoij, M.D., Ph.D., Harry J.G.M. Crijns, M.D., Ph.D., Gillian A.J. Jessurun, M.D., Ph.D., Pranobe V. Oemrawsingh, M.D., Ph.D., Marcel T.M. Gosselink, M.D., Ph.D., Koos Plomp, M.D., Michael Magro, M.D., Ph.D., Paul W.G. Elbers, M.D., Ph.D., Peter M. van de Ven, Ph.D., Heleen M. Oudemans-van Straaten, M.D., Ph.D., and Niels van Royen, M.D., Ph.D.
From the Departments of Cardiology (J.S.L., G.N.J., N.W.H., N.R.), Intensive Care Medicine (P.W.G.E., H.M.O.-S.), and Epidemiology and Biostatistics (P.M.V.), Amsterdam University Medical Center VUmc, the Departments of Cardiology (J.P.H.) and Intensive Care Medicine (A.P.J.V.), Amsterdam University Medical Center AMC, and the Departments of Cardiology (M.A.V.) and Intensive Care Medicine (B.B.), Onze Lieve Vrouwe Gasthuis, Amsterdam, the Thorax Center, Erasmus Medical Center (L.S.D.J., E.A.D.), and the Departments of Cardiology (G.J.V.) and Intensive Care Medicine (B.J.W.E.), Maasstad Hospital, Rotterdam, the Departments of Cardiology (M. Meuwissen) and Intensive Care Medicine (T.A.R.), Amphia Hospital, Breda, the Departments of Cardiology (H.A.B.) and Intensive Care Medicine (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Cardiology (G.B.B.) and Intensive Care Medicine (R.B.), Haga Hospital, and the Department of Cardiology, Haaglanden Medical Center (P.V.O.), The Hague, the Departments of Cardiology (P.H.) and Intensive Care Medicine (I.C.C.H.), University of Groningen, Groningen, the Departments of Cardiology (M.V.) and Intensive Care Medicine (J.J.H.), University Medical Center Utrecht, Utrecht, the Departments of Intensive Care Medicine (A.B.) and Cardiology (M.S.), Medisch Spectrum Twente, Enschede, the Departments of Cardiology (C.C., N.R.) and Intensive Care Medicine (H.H.), Radboud University Medical Center, Nijmegen, the Departments of Cardiology (T.A.C.M.H.) and Intensive Care Medicine (W.R.), Noordwest Ziekenhuisgroep, Alkmaar, the Departments of Intensive Care Medicine (T.S.R.D.) and Cardiology (H.J.G.M.C.), Maastricht University Medical Center, Maastricht, the Department of Cardiology, Scheper Hospital, Emmen (G.A.J.J.), the Department of Cardiology, Isala Hospital, Zwolle (M.T.M.G.), the Department of Cardiology, Tergooi Hospital, Blaricum (K.P.), and the Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg (M. Magro) — all in the Netherlands. Address reprint requests to Dr. Lemkes at the Department of Cardiology, Amsterdam University Medical Center VUmc, De Boelelaan 1117, 1081HV, Amsterdam, the Netherlands, or at j.lemkes@vumc.nl.

 

参考文献

1. Patel N, Patel NJ, Macon CJ, et al. Trends and outcomes of coronary angiography and percutaneous coronary intervention after out-of-hospital cardiac arrest associated with ventricular fibrillation or pulseless ventricular tachycardia. JAMA Cardiol 2016;1:890-899.

2. Spaulding CM, Joly L-M, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 1997;336:1629-1633.

3. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119-177.

4. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61(4):e78-e140.

5. Bro-Jeppesen J, Kjaergaard J, Wanscher M, et al. Emergency coronary angiography in comatose cardiac arrest patients: do real-life experiences support the guidelines? Eur Heart J Acute Cardiovasc Care 2012;1:291-301.

6. Dankiewicz J, Nielsen N, Annborn M, et al. Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography: a post hoc analysis from the TTM trial. Intensive Care Med 2015;41:856-864.

7. Dumas F, Bougouin W, Geri G, et al. Emergency percutaneous coronary intervention in post-cardiac arrest patients without ST-segment elevation pattern: insights from the PROCAT II registry. JACC Cardiovasc Interv 2016;9:1011-1018.

8. Hollenbeck RD, McPherson JA, Mooney MR, et al. Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI. Resuscitation 2014;85:88-95.

9. Staudacher II, den Uil C, Jewbali L, et al. Timing of coronary angiography in survivors of out-of-hospital cardiac arrest without obvious extracardiac causes. Resuscitation 2018;123:98-104.

10. Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care. Intensive Care Med 2015;41:2039-2056.

11. Welsford M, Nikolaou NI, Beygui F, et al. Part 5: acute coronary syndromes: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2015;132:Suppl 1:S146-S176.

12. Noc M, Fajadet J, Lassen JF, et al. Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European Association for Percutaneous Cardiovascular Interventions (EAPCI)/Stent for Life (SFL) groups. EuroIntervention 2014;10:31-37.

13. Rab T, Kern KB, Tamis-Holland JE, et al. Cardiac arrest: a treatment algorithm for emergent invasive cardiac procedures in the resuscitated comatose patient. J Am Coll Cardiol 2015;66:62-73.

14. Lemkes JS, Janssens GN, Straaten HM, et al. Coronary angiography after cardiac arrest: rationale and design of the COACT trial. Am Heart J 2016;180:39-45.

15. Serruys PW, Morice M-C, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-972.

16. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11(2):R31-R31.

17. Larsen JM, Ravkilde J. Acute coronary angiography in patients resuscitated from out-of-hospital cardiac arrest — a systematic review and meta-analysis. Resuscitation 2012;83:1427-1433.

18. Khan MS, Shah SMM, Mubashir A, et al. Early coronary angiography in patients resuscitated from out of hospital cardiac arrest without ST-segment elevation: a systematic review and meta-analysis. Resuscitation 2017;121:127-134.

19. Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503-1516.

20. Montalescot G, Cayla G, Collet JP, et al. Immediate vs delayed intervention for acute coronary syndromes: a randomized clinical trial. JAMA 2009;302:947-954.

21. Riezebos RK, Ronner E, Ter Bals E, et al. Immediate versus deferred coronary angioplasty in non-ST-segment elevation acute coronary syndromes. Heart 2009;95:807-812.

22. Thiele H, Rach J, Klein N, et al. Optimal timing of invasive angiography in stable non-ST-elevation myocardial infarction: the Leipzig Immediate versus early and late PercutaneouS coronary Intervention triAl in NSTEMI (LIPSIA-NSTEMI Trial). Eur Heart J 2012;33:2035-2043.

23. Milosevic A, Vasiljevic-Pokrajcic Z, Milasinovic D, et al. Immediate versus delayed invasive intervention for non-STEMI patients: the RIDDLE-NSTEMI Study. JACC Cardiovasc Interv 2016;9:541-549.

24. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 2013;369:2197-2206.

25. Laver S, Farrow C, Turner D, Nolan J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 2004;30:2126-2128.

26. Erlinge D, Götberg M, Lang I, et al. Rapid endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction — the CHILL-MI trial: a randomized controlled study of the use of central venous catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction. J Am Coll Cardiol 2014;63:1857-1865.

27. Kim F, Nichol G, Maynard C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA 2014;311:45-52.

28. Bernard SA, Smith K, Cameron P, et al. Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial. Circulation 2010;122:737-742.

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