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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: https://doi.org/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

1. Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 2005;67:75–80. doi: 10.1016/j.resuscitation.2005.03.021 16199289

2. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation 2010;81:1479–87. doi: 10.1016/j.resuscitation.2010.08.006 20828914

3. Eisenberg MS, Mengert TJ. Cardiac resuscitation. N Engl J Med 2001;344:1304–13. doi: 10.1056/NEJM200104263441707 11320390

4. Bunch TJ, White RD, Gersh BJ, Meverden RA, Hodge DO, Ballman KV, et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 2003;348:2626–33. doi: 10.1056/NEJMoa023053 12826637

5. Grubb NR, Fox KAA, Elton RA. In-hospital mortality after out-of-hospital cardiac arrest. The Lancet 1995;346:417–21.

6. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002;346:557–63. doi: 10.1056/NEJMoa003289 11856794

7. Kern KB, Lotun K, Patel N, Mooney MR, Hollenbeck RD, McPherson JA, et al. Outcomes of Comatose Cardiac Arrest Survivors With and Without ST-Segment Elevation Myocardial Infarction: Importance of Coronary Angiography. JACC Cardiovasc Interv 2015;8:1031–40. doi: 10.1016/j.jcin.2015.02.021 26117462

8. Dumas F, Cariou A, Manzo-Silberman S, Grimaldi D, Vivien B, Rosencher J, et al. Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry. Circ Cardiovasc Interv 2010;3:200–7. doi: 10.1161/CIRCINTERVENTIONS.109.913665 20484098

9. Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569–619. doi: 10.1093/eurheartj/ehs215 22922416

10. Anyfantakis ZA, Baron G, Aubry P, Himbert D, Feldman LJ, Juliard JM, et al. Acute coronary angiographic findings in survivors of out-of-hospital cardiac arrest. Am Heart J 2009;157:312–8. doi: 10.1016/j.ahj.2008.09.016 19185639

11. Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 2004;63:233–49. doi: 10.1016/j.resuscitation.2004.09.008 15582757

12. Abramson NS, Detre K, Bradley K, Kelsey SF, Ricci E, Safar P, et al. Impact evaluation in resuscitation research: discussion of clinical trials. Crit Care Med 1988;16:1053–8. doi: 10.1097/00003246-198810000-00019 3168495

13. Soholm H, Kjaergaard J, Bro-Jeppesen J, Hartvig-Thomsen J, Lippert F, Kober L, et al. Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2015;8:268–76. doi: 10.1161/CIRCOUTCOMES.115.001767 25944632

14. Strote JA, Maynard C, Olsufka M, Nichol G, Copass MK, Cobb LA, et al. Comparison of Role of Early (<6 Hours) to Later (>6 Hours) or No Cardiac Catheterization Following Resuscitation From Out-of-hospital Cardiac Arrest. The American Journal of Cardiology 2012;109:451–4. doi: 10.1016/j.amjcard.2011.09.036 22100026

15. Hollenbeck RD, McPherson JA, Mooney MR, Unger BT, Patel NC, McMullan PW Jr., et al. Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI. Resuscitation 2014;85:88–95. doi: 10.1016/j.resuscitation.2013.07.027 23927955

16. Gupta T, Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, et al. Relation of smoking status to outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest. Am J Cardiol 2014;114:169–74. doi: 10.1016/j.amjcard.2014.04.021 24878124

17. Roberts A. Cardiac resuscitation: The 'smoker's paradox' after in-hospital cardiac arrest. Nat Rev Cardiol 2014; 11:374.

18. Zanuttini D, Armellini I, Nucifora G, Carchietti E, Trillò G, Spedicato L, et al. Impact of Emergency Coronary Angiography on In-Hospital Outcome of Unconscious Survivors After Out-of-Hospital Cardiac Arrest. The American Journal of Cardiology 2012;110:1723–8. doi: 10.1016/j.amjcard.2012.08.006 22975468

19. Wibrandt I, Norsted K, Schmidt H, Schierbeck J. Predictors for outcome among cardiac arrest patients: the importance of initial cardiac arrest rhythm versus time to return of spontaneous circulation, a retrospective cohort study. BMC Emergency Medicine 2015;15:3. doi: 10.1186/s12873-015-0028-3 25648841

20. Rittenberger JC, Raina K, Holm MB, Kim YJ, Callaway CW. Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac arrest. Resuscitation 2011;82:1036–40. doi: 10.1016/j.resuscitation.2011.03.034 21524837

21. Camuglia AC, Randhawa VK, Lavi S, Walters DL. Cardiac catheterization is associated with superior outcomes for survivors of out of hospital cardiac arrest: review and meta-analysis. Resuscitation 2014;85:1533–40. doi: 10.1016/j.resuscitation.2014.08.025 25195073

22. Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio VJ, et al. Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest. New England Journal of Medicine 2004;351:647–56. doi: 10.1056/NEJMoa040325 15306666

23. Blom MT, Beesems SG, Homma PC, Zijlstra JA, Hulleman M, van Hoeijen DA, et al. Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators. Circulation 2014;130:1868–75. doi: 10.1161/CIRCULATIONAHA.114.010905 25399395

24. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37:267–315. doi: 10.1093/eurheartj/ehv320 26320110

25. Adrie C, Cariou A, Mourvillier B, Laurent I, Dabbane H, Hantala F, et al. Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score. Eur Heart J 2006;27:2840–5. doi: 10.1093/eurheartj/ehl335 17082207

26. Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K, et al. Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest. N Engl J Med 2017;376:1737–47. doi: 10.1056/NEJMoa1601891 28467879

27. Stiell I, Nichol G, Wells G, De Maio V, Nesbitt L, Blackburn J, et al. Health-related quality of life is better for cardiac arrest survivors who received citizen cardiopulmonary resuscitation. Circulation 2003;108:1939–44. doi: 10.1161/01.CIR.0000095028.95929.B0 14530198


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