Long-term outcomes among out-of-hospital cardiac arrest survivors with reversible vs. non-reversible causes.

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Acute Cardiovascular Care Pub Date : 2024-10-28 DOI:10.1093/ehjacc/zuae097

Carlo Alberto Barcella, Brian E Grunau, Meijiao Guan, Nathaniel M Hawkins, Marc W Deyell, Jason G Andrade, Jennie S Helmer, Graham C Wong, Kristian H Kragholm, Karin H Humphries, Jim Christenson, Christopher B Fordyce

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Abstract

Aims: A reversible cause of out-of-hospital cardiac arrest (OHCA) is vaguely defined in international guidelines as an identifiable transient or potentially correctable condition. However, studies evaluating long-term outcomes of patients experiencing OHCA due to reversible and non-reversible causes are lacking. We aimed to determine differences in long-term outcomes in OHCA survivors according to different aetiology.

Methods and results: From the British Columbia Cardiac Arrest registry, adults with non-traumatic OHCA (2009-2016) surviving to hospital discharge were identified. Patients were categorized by OHCA aetiology combining reversibility and underlying ischaemic aetiology. The primary outcome was a composite of all-cause mortality, recurrent OHCA, or re-hospitalization for sudden cardiac arrest or ventricular arrhythmias. Using the Kaplan-Meier method and multivariable Cox regression models, we compared the risk of the composite outcome according to different OHCA aetiology. Of 1325 OHCA hospital-discharge survivors (median age 62.8 years, 77.9% male), 431 (32.5%) had reversible ischaemic, 415 (31.3%), non-reversible ischaemic, 99 (7.5%), reversible non-ischaemic, and 380 (28.7%), non-reversible non-ischaemic aetiologies. At 3 years post discharge, the Kaplan-Meier event-free rate was highest in patients with a reversible ischaemic aetiology [91%, 95% confidence interval (CI) 87-94%], and lowest in those with a reversible non-ischaemic aetiology (62%, 95% CI 51-72%). In multivariate analyses, compared with non-reversible non-ischaemic cause, reversible ischaemic cause was associated with a significantly lower hazard ratio (HR; 0.52, 95% CI 0.33-0.81), reversible non-ischaemic cause with a significantly higher HR (1.53, 95% CI 1.03-2.32), and non-reversible ischaemic cause with a non-significant HR (0.92, 95% CI 0.64-1.33) for the composite outcome.

Conclusion: Compared to other aetiologies, the presence of a reversible ischaemic cause is associated with improved long-term OHCA outcomes.

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可逆与不可逆性院外心脏骤停幸存者的长期预后。

背景：院外心脏骤停（OHCA）的可逆原因在国际指南中被模糊地定义为可识别的短暂或潜在的可纠正情况。此外，缺乏对可逆和不可逆性原因导致的院外心脏骤停患者的长期预后进行评估的研究。我们旨在确定不同病因导致的 OHCA 幸存者长期预后的差异：我们从不列颠哥伦比亚省心脏骤停登记处收集了2009-2016年出院后存活的非创伤性OHCA成人患者。患者按OHCA病因分类，结合可逆性和潜在缺血性病因。主要结果是全因死亡率、复发性 OHCA 或因心脏骤停或室性心律失常再次住院的复合结果。我们使用 Kaplan-Meier 方法和多变量 Cox 回归模型，比较了不同 OHCA 病因导致的综合结果的风险：在1325名OHCA出院幸存者（中位年龄62.8岁，77.9%为男性）中，431人（32.5%）病因为可逆性缺血，415人（31.3%）病因为非可逆性缺血，99人（7.5%）病因为可逆性非缺血，380人（28.7%）病因为非可逆性非缺血。出院后 3 年，可逆性缺血性病因患者的 Kaplan-Meier 无事件率最高（91%，95% CI 87-94%），可逆性非缺血性病因患者的 Kaplan-Meier 无事件率最低（62%，95% CI 51-72%）。在多变量分析中，与不可逆的非缺血性病因相比，可逆的缺血性病因与综合结果相关的危险比（HR）明显较低（0.52，95% 置信区间[CI]，0.33-0.81），可逆的非缺血性病因与综合结果相关的危险比（HR）明显较高（1.53，95% CI，1.03-2.32），而不可逆的缺血性病因与综合结果相关的危险比（HR）为 0.92（95% CI，0.64-1.33）：结论：可逆性缺血原因的存在与OHCA的长期结果有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal: Acute Cardiovascular Care Medicine-General Medicine

CiteScore

8.50

自引率

4.90%

发文量

325

期刊介绍： The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.