Risk Stratification Among Survivors of Cardiac Arrest Considered for Coronary Angiography

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:77

Article

Harhash, Ahmed A.^1,2  May, Teresa L.³  Hsu, Chiu-Hsieh⁴  Agarwal, Sachin⁵  Seder, David B.³  Mooney, Michael R.⁶  Patel, Nainesh⁷  McPherson, John⁸  McMullan, Paul⁹  Riker, Richard³  Soreide, Eldar¹⁰  Hirsch, Karen G.¹¹  Stammet, Pascal¹²  Dupont, Alison¹³  Rubertsson, Sten¹⁴  Friberg, Hans¹⁵  Nielsen, Niklas¹⁵  Rab, Tanveer¹⁶  Kern, Karl B.¹ 

[1] Univ Arizona, Sarver Heart Ctr, Tucson, AZ USA

[2] Univ Vermont, Burlington, VT USA

[3] Maine Med Ctr, Portland, ME 04102 USA

[4] Univ Arizona, Coll Publ Hlth, Tucson, AZ USA

[5] Columbia Univ, New York, NY USA

[6] Minneapolis Heart Inst, Minneapolis, MN USA

[7] Lehigh Valley Med Ctr, Lehigh, PA USA

[8] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[9] St Thomas Heart, Nashville, TN USA

[10] Stavanger Univ Hosp, Stavanger, Norway

[11] Stanford Univ, Stanford, CA 94305 USA

[12] Natl Fire & Rescue Corps, Luxembourg, Luxembourg

[13] Northside Hosp, Lawrenceville, GA USA

[14] Uppsala Univ, Uppsala, Sweden

[15] Lund Univ, Helsingborg, Sweden

[16] Emory Univ, Sch Med, Atlanta, GA USA

关键词: cardiac arrest;    coronary;    angiography;    risk stratification;   

DOI  :  10.1016/j.jacc.2020.11.043

来源: Elsevier

【 摘 要 】

BACKGROUND The American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival. OBJECTIVES This study sought to identify how many unfavorable features are required before prognosis is significantly worsened and which features are most impactful in predicting prognosis. METHODS Using the INTCAR (International Cardiac Arrest Registry), the impact of each proposed unfavorable feature on survival to hospital discharge was individually analyzed. Logistic regression was performed to assess the association of such unfavorable features with poor outcomes. RESULTS Seven unfavorable features (of 10 total) were captured in 2,508 patients successfully resuscitated after cardiac arrest (ongoing cardiopulmonary resuscitation and noncardiac etiology were exclusion criteria in our registry). Chronic kidney disease was used in lieu of end-stage renal disease. In total, 39% survived to hospital discharge. The odds ratio (OR) of survival to hospital discharge for each unfavorable feature was as follows: age>85 years OR: 0.30 (95% CI: 0.15 to 0.61), time-to-ROSC >30 min OR: 0.30 (95% CI: 0.23 to 0.39), nonshockable rhythm OR: 0.39 (95% CI: 0.29 to 0.54), no bystander cardiopulmonary resuscitation OR: 0.49 (95% CI: 0.38 to 0.64), lactate >7 mmol/l OR: 0.50 (95% CI: 0.40 to 0.63), unwitnessed arrest OR: 0.58 (95% CI: 0.44 to 0.78), pH <7.2 OR: 0.78 (95% CI: 0.63 to 0.98), and chronic kidney disease OR: 0.96 (95% CI: 0.70 to 1.33). The presence of any 3 or more unfavorable features predicted <40% survival. Presence of the 3 strongest risk factors (age>85 years, time-to-ROSC>30 min, and non-ventricular tachycardia/ventricular fibrillation) together or <= 6 unfavorable features predicted a <= 10% chance of survival to discharge. CONCLUSIONS Patients successfully resuscitated from cardiac arrest with 6 or more unfavorable features have a poor long-term prognosis. Delaying or even forgoing invasive procedures in such patients is reasonable. (c) 2021 by the American College of Cardiology Foundation.

【 授权许可】

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