European Heart Journal: Acute Cardiovascular Care最新文献

Aims: Changes in ventricular repolarisation, observed as QTc prolongation, are frequently observed following cardiac arrest. The T-peak to T-end (TpTe) interval represents a period of increased susceptibility to ventricular arrhythmia. We posit that TpTe prolongation may be associated with adverse clinical outcomes in patients resuscitated from cardiac arrest.

Methods and results: We included patients aged ≥18 years with both out-of-hospital and in-hospital cardiac arrest following return of spontaneous circulation (ROSC) who had an electrocardiogram (ECG) obtained within 24 h following ROSC. The first ECG obtained was evaluated to determine the QTc and TpTe intervals. Hierarchical logistic regression was used to evaluate the association between prolongation of the QTc and TpTe intervals and clinical outcomes (in-hospital mortality and favourable neurologic outcome at hospital discharge). We included 443 patients, with a median age of 61 years (IQR: 50-72 years), 60.5% male, 65.7% OHCA, and 29.8% with initial shockable rhythm. Overall, 310 patients had QTc prolongation (70.0%), and 284 had TpTe prolongation (64.1%). Patients with TpTe prolongation had a greater incidence of initial shockable rhythm (35.6% vs. 19.5%, P < 0.001) and higher initial lactate (8.6 vs. 7.4 mmol/L, P = 0.03). QTc prolongation was not associated with in-hospital mortality [odds ratio (OR):1.27, 95% confidence interval (CI): 0.75-2.14, P = 0.37] or favourable neurologic outcome (OR: 0.88, 95% CI: 0.50-1.54, P = 0.65). TpTe prolongation was independently associated with in-hospital mortality (OR: 1.69, 95% CI: 1.01-2.85, P = 0.05) but not favourable neurologic outcome (OR: 0.78, 95% CI: 0.45-1.37, P = 0.39).

Conclusion: TpTe interval prolongation, but not QTc interval prolongation, was associated with increased in-hospital mortality in patients resuscitated from cardiac arrest.

Aims: The NULL-PLEASE score (Non-shockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH <7.2, Lactate >7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) was developed to predict survival in out-of-hospital cardiac arrest (OHCA) patients. Because survival differs between sexes, we aimed to validate NULL-PLEASE separately in men and women.

Methods and results: Men and women with return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival from 2001 to 2019 were identified using Danish nationwide registries. The primary outcome was 1-day mortality. Secondary outcomes were defined as 30-day mortality and the combination of 1-year mortality or anoxic brain damage. Logistic regression was used for outcome risk estimation (reference: NULL-PLEASE = 0). Interaction analyses were performed between the NULL-PLEASE score and sex. The predictive ability was assessed using area under the receiver operating characteristics (AUCROC) curves. We included 2599 men and 1280 women. One-day mortality for men and women was 36% and 50%; 30-day mortality was 56% and 71%; and 63% and 78% experienced the combined 1-year outcome. AUCROC values for 1-day mortality were for men: 0.828 (95% CI: 0.813-0.844); and for women: 0.754 (95% CI: 0.728-0.780). Results were similar for secondary outcomes. We found significant interaction between the NULL-PLEASE score and sex: 1-day mortality: P < 0.001, 30-day mortality: P = 0.04, combined outcome: P = 0.09.

Conclusion: In a nationwide OHCA-cohort, the predictive ability of the NULL-PLEASE score was higher in men than in women.

Aims: This study aimed to assess mortality rates in resuscitated comatose out-of-hospital cardiac arrest (OHCA) patients with and without diabetes randomized to targets of blood pressure, oxygen, and duration of fever prevention.

Methods and results: Diabetic and non-diabetic patients from the BOX trial were compared. The BOX trial was a randomized, controlled, multicentre study comparing two mean arterial blood pressure targets (63 vs. 77 mmHg) in a double-blinded intervention and two open-labelled targets including a liberal and restrictive oxygenation (9-10 vs. 13-14 kPa) target and two regimes for length of fever control (36 vs. 72 h). The primary outcome for this substudy is 365-day survival. Multiple logistic regression models were used to adjust for factors known to be associated with outcome including age, sex, witnessed arrest (y/n), and time to return of spontaneous circulation (min). A total of 110 (14%) patients had pre-existing diabetes. Compared with the non-diabetic group, the patients with diabetes were older [median years (IQR) 67 (59; 73) vs. 63 (53; 72)] and had more comorbidities. The diabetic patients had an overall increased 365-day all-cause mortality (45% vs. 34%, P = 0.02). The logistic regression model adjusting for age and sex, witnessed arrest (y/n), and place of arrest gave an estimated adjusted odds ratio of 1.47 (0.93-2.30) (P = 0.10). No significant interactions were observed among interventions and outcomes related to diabetes status, P ranging from 0.10 to 0.80.

Conclusion: Pre-existing diabetes was associated with an increased crude 365-day mortality. No differences in outcome were observed among diabetic OHCA patients depending on the assessed blood pressure targets, oxygen levels, and durations of fever control.