Predicting factors for long-term survival in patients with out-of-hospital cardiac arrest – A propensity score-matched analysis


Autoři: Anna Lena Lahmann aff001;  Dario Bongiovanni aff002;  Anna Berkefeld aff002;  Maximilian Kettern aff001;  Lucas Martinez aff001;  Rainer Okrojek aff002;  Petra Hoppmann aff002;  Karl-Ludwig Laugwitz aff002;  Patrick Mayr aff004;  Salvatore Cassese aff001;  Robert Byrne aff001;  Sebastian Kufner aff001;  Erion Xhepa aff001;  Heribert Schunkert aff001;  Adnan Kastrati aff001;  Michael Joner aff001
Působiště autorů: Department of Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany aff001;  Department of Cardiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany aff002;  DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany aff003;  Department of Anesthesiology, German Heart Center Munich, Technical University Munich, Munich, Germany aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0218634

Souhrn

Background

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death worldwide, with acute coronary syndromes accounting for most of the cases. While the benefit of early revascularization has been clearly demonstrated in patients with ST-segment-elevation myocardial infarction (STEMI), diagnostic pathways remain unclear in the absence of STEMI. We aimed to characterize OHCA patients presenting to 2 tertiary cardiology centers and identify predicting factors associated with survival.

Methods

We retrospectively analyzed 519 patients after OHCA from February 2003 to December 2017 at 2 centers in Munich, Germany. Patients undergoing immediate coronary angiography (CAG) were compared to those without. Multivariate regression analysis and inverse probability treatment weighting (IPTW) were performed to identify predictors for improved outcome in a matched population.

Results

Immediate CAG was performed in 385 (74.1%) patients after OHCA with presumed cardiac cause of arrest. As a result of multivariate analysis after propensity score matching, we found that immediate CAG, return of spontaneous circulation (ROSC) at admission, witnessed arrest and former smoking were associated with improved 30-days-survival [(OR, 0.46; 95% CI, 0.26–0.84), (OR, 0.21; 95% CI, 0.10–0.45), (OR, 0.50; 95% CI, 0.26–0.97), (OR, 0.43; 95% CI, 0.23–0.81)], and 1-year-survival [(OR, 0.39; 95% CI, 0.19–0.82), (OR, 0.29; 95% CI, 0.12–0.7), (OR, 0.43; 95% CI, 0.2–1.00), (OR, 0.3; 95% CI, 0.14–0.63)].

Conclusions

In our study, immediate CAG, ROSC at admission, witnessed arrest and former smoking were independent predictors of survival in cardiac arrest survivors. Improvement in prehospital management including bystander CPR and best practice post-resuscitation care with optimized triage of patients to an early invasive strategy may help ameliorate overall outcome of this critically-ill patient population.

Klíčová slova:

Angiography – Cardiac arrest – Coronary angioplasty – Coronary heart disease – Coronary revascularization – Electrocardiography – Lesions – Triage


Zdroje

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