Lack of Early Etiologic Investigations in Young Sudden Cardiac Death,Resuscitation

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Lack of Early Etiologic Investigations in Young Sudden Cardiac Death
Resuscitation ( IF 6.5 ) Pub Date : 2022-07-03 , DOI: 10.1016/j.resuscitation.2022.06.023
Ardalan Sharifzadehgan ₁ , Bamba Gaye ₂ , Wulfran Bougouin ₃ , Kumar Narayanan ₄ , Florence Dumas ₅ , Nicole Karam ₁ , Julien Rischard ₆ , Isabelle Plu ₇ , Victor Waldmann ₁ , Vincent Algalarrondo ₈ , Estelle Gandjbakhch ₉ , Patrick Bruneval ₁₀ , Frankie Beganton ₁₁ , Christine Alonso ₁₂ , Ghassan Moubarak ₁₂ , Olivier Piot ₁₃ , Lionel Lamhaut ₁₄ , Daniel Jost ₁₅ , Georgios Sideris ₁₆ , Nicolas Mansencal ₁₇ , Nicolas Deye ₁₈ , Sebastian Voicu ₁₈ , Bruno Megarbane ₁₈ , Guillaume Geri ₁₉ , Antoine Vieillard-Baron ₂₀ , Nicolas Lellouche ₂₁ , Fabrice Extramiana ₈ , Karim Wahbi ₂₂ , Olivier Varenne ₂₂ , Alain Cariou ₂₃ , Xavier Jouven ₁ , Eloi Marijon ₂₄ ,

Affiliation

European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), Paris, France; University of Paris Cité, Paris, France.
Paris Cardiovascular Research Center (PARCC), Paris, France; University of Paris Cité, Paris, France.
Paris Cardiovascular Research Center (PARCC), Paris, France; Jacques Cartier Hospital, Intensive Care Unit, Massy, France.
Paris Cardiovascular Research Center (PARCC), Paris, France; Medicover Hospitals, Cardiology Department, Hyderabad, India.
Paris Cardiovascular Research Center (PARCC), Paris, France; University of Paris Cité, Paris, France; Cochin Hospital, Emergency Department, Paris, France.
European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), Paris, France.
Forensic Medical Institute, Paris, France.
Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France.
Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France.
University of Paris Cité, Paris, France; European Georges Pompidou Hospital, Pathology Department, Paris, France.
Paris Cardiovascular Research Center (PARCC), Paris, France.
Centres Médico Chirurgicaux Ambroise Paré, Neuilly-sur-Seine, France.
Centre Cardiologique du Nord, Saint Denis, France.
Paris Cardiovascular Research Center (PARCC), Paris, France; University of Paris Cité, Paris, France; Emergency Medical Services (SAMU) 75, Necker University Hospital, APHP, Paris, France.
Paris Cardiovascular Research Center (PARCC), Paris, France; Paris Firefighters Brigade (BSPP), Paris, France.
Lariboisiere Hospital, Cardiology Department, Paris, France.
Ambroise Paré Hospital, Cardiology Intensive Care Unit, Paris, France.
Lariboisiere Hospital, Intensive Care Unit, Paris, France.
Paris Cardiovascular Research Center (PARCC), Paris, France; Ambroise Paré Hospital, Intensive Care Unit, Paris, France.
Ambroise Paré Hospital, Intensive Care Unit, Paris, France.
University Hospital Henri Mondor, Cardiology Department, Créteil, France.
University of Paris Cité, Paris, France; Cochin Hospital, Cardiology Intensive Care Unit, Paris, France.
Paris Cardiovascular Research Center (PARCC), Paris, France; University of Paris Cité, Paris, France; Cochin Hospital, Intensive Care Unit, Paris, France.
European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), Paris, France; University of Paris Cité, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France.

Background

Since majority of sudden cardiac arrest (SCA) victims die in the intensive care unit (ICU), early etiologic investigations may improve understanding of SCA and targeted prevention.

Methods

In this prospective, population-based registry all SCA admitted alive across the 48 hospitals of the Paris area were enrolled. We investigated the extent of early etiologic work-up among young SCD cases (<45 years) eventually dying within the ICU.

Results

From May 2011 to May 2018, 4,314 SCA patients were admitted alive. Among them, 3,044 died in ICU, including 484 (15.9%) young patients. SCA etiology was established in 233 (48.1%) and remained unexplained in 251 (51.9%). Among unexplained (compared to explained) cases, coronary angiography (17.9 vs. 49.4%, P<0.001), computed tomography scan (24.7 vs. 46.8%, P<0.001) and trans-thoracic echocardiography (31.1 vs. 56.7%, P<0.001) were less frequently performed. Only 22 (8.8%) patients with unexplained SCD underwent all three investigations. SCDs with unexplained status decreased significantly over the 7 years of the study period (from 62.9 to 35.2%, P=0.005). While specialized TTE and CT scan performances have increased significantly, performance of early coronary angiography did not change. Autopsy, genetic analysis and family screening were performed in only 48 (9.9%), 5 (1.0%) and 14 cases (2.9%) respectively.

Conclusions

More than half of young SCD dying in ICU remained etiologically unexplained; this was associated with a lack of early investigations. Improving early diagnosis may enhance both SCA understanding and prevention, including for relatives. Failure to identify familial conditions may result in other preventable deaths within these families.

中文翻译：

年轻心源性猝死缺乏早期病因学调查

背景

由于大多数心脏骤停 (SCA) 受害者死于重症监护病房 (ICU)，因此早期病因学调查可能会提高对 SCA 和针对性预防的理解。

方法

在这个基于人群的前瞻性登记中，巴黎地区 48 家医院中所有活着的 SCA 都被登记。我们调查了最终在 ICU 内死亡的年轻 SCD 病例（<45 岁）的早期病因检查范围。

结果

从 2011 年 5 月到 2018 年 5 月，共有 4,314 名 SCA 患者活着入院。其中，3044人死于ICU，其中年轻患者484人（15.9%）。SCA 病因在 233 例（48.1%）中确定，在 251 例（51.9%）中仍未得到解释。在无法解释（与已解释）病例中，冠状动脉造影（17.9 对 49.4%，P<0.001）、计算机断层扫描（24.7 对 46.8%，P<0.001）和经胸超声心动图（31.1 对 56.7%，P <0.001) 较少执行。只有 22 名 (8.8%) 原因不明的 SCD 患者接受了所有三项调查。在研究期间的 7 年中，状态不明的 SCD 显着减少（从 62.9% 降至 35.2%，P=0.005）。虽然专业的 TTE 和 CT 扫描性能显着提高，但早期冠状动脉造影的性能没有改变。尸检，