Abstract

Objectives. Implantable cardioverter defibrillator (ICD) implantation in patients resuscitated from out-of-hospital cardiac arrest (OHCA) due to acute myocardial infarction (AMI) is controversial. Design. Consecutive OHCA-survivors due to AMI from two Danish tertiary heart centers from 2007 to 2011 were included. Predictors of ICD-implantation, ICD-therapy and long-term survival (5 years) were investigated. Patients with and without ICD-implantation during the index hospital admission were included (later described as early ICD-implantation). Patients with an ICD after hospital discharge were censored from further analyses at time of implantation. Results. We identified 1,457 consecutive OHCA-patients, and 292 (20%) of the cohort met the inclusion criteria. An ICD was implanted during hospital admission in 78 patients (27%). STEMI and successful revascularization were inversely and independently associated with ICD-implantation (OR_STEMI = 0.37, 95% CI: 0.14–0.94, OR_revasc = 0.11, 0.03–0.36) whereas age, sex, LVEF <35%, comorbidity burden or shockable first OHCA-rhythm were not associated with ICD-implantation. Appropriate ICD-shock therapy during the follow-up period was noted in 15% of patients (n = 12). Five-year mortality-rate was significantly lower in ICD-patients (18% vs. 28%, p_logrank = 0.02), which was persistent after adjustment for prognostic factors (HR = 0.44 (95% CI: 0.23–0.88)). This association was no longer found when using first event (death or appropriate shock whatever came first) as outcome variable (p_logrank = 0.9). Conclusions. Mortality after OHCA due to AMI was significantly lower in patients with early ICD-implantation after adjustment for prognostic factors. When using appropriate shock and death as events, ICD-patients had similar outcome as patients without an ICD, which may suggest a survival benefit due to appropriate device therapy.

摘要

目标。在因急性心肌梗死 (AMI) 导致院外心脏骤停 (OHCA) 复苏的患者中植入植入式心律转复除颤器 (ICD) 存在争议。设计。包括 2007 年至 2011 年期间来自两个丹麦三级心脏中心的 AMI 导致的连续 OHCA 幸存者。研究了 ICD 植入、ICD 治疗和长期生存（5 年）的预测因素。包括首次入院期间植入和未植入 ICD 的患者（后来称为早期 ICD 植入）。出院后植入 ICD 的患者在植入时的进一步分析中被剔除。结果。我们确定了 1,457 名连续的 OHCA 患者，队列中有 292 名 (20%) 符合纳入标准。78 名患者（27%）在入院期间植入了 ICD。STEMI 和成功的血运重建与 ICD 植入呈负相关且独立相关（OR _STEMI = 0.37, 95% CI: 0.14–0.94, OR _revasc = 0.11, 0.03–0.36），而年龄、性别、LVEF <35%、合并症负担或可电击第一个 OHCA 节律与 ICD 植入无关。15% 的患者 ( n  = 12)在随访期间进行了适当的 ICD 电击治疗。ICD 患者的五年死亡率显着降低（18% 对 28%，p _logrank= 0.02)，在调整预后因素后仍然存在（HR = 0.44（95% CI：0.23–0.88））。当使用第一个事件（死亡或适当的休克）作为结果变量（p _logrank = 0.9）时，不再发现这种关联。结论。在调整预后因素后，早期植入 ICD 的患者因 AMI 进行 OHCA 后的死亡率显着降低。当使用适当的休克和死亡作为事件时，ICD 患者的结果与没有 ICD 的患者相似，这可能表明由于适当的装置治疗，生存获益。