Aim

Treatment with certain drugs can augment the risk of developing malignant arrhythmias (e.g. torsades de pointes [TdP]). Hence, we examined the overall TdP risk drug use before out-of-hospital cardiac arrest (OHCA) and possible association with shockable rhythm and return of spontaneous circulation (ROSC).

Methods

Patients ≥18 years with an OHCA of cardiac origin from the Danish Cardiac Arrest Registry (2001–2014) and TdP risk drug use according to www.CredibleMeds.org were identified. Factors associated with TdP risk drug use and secondly how use may affect shockable rhythm and ROSC were determined by multivariable logistic regression.

Results

We identified 27,481 patients with an OHCA of cardiac origin (median age: 72 years [interquartile range 62.0, 80.0 years]). A total of 37% were in treatment with TdP risk drugs 0–30 days before OHCA compared with 33% 61–90 days before OHCA (p < 0.001). Most commonly used TdP risk drugs were citalopram (36.1%) and roxithromycin (10.7%). Patients in TdP risk drug treatment were older (75 vs 70 years) and more comorbid compared with those not in treatment. Subsequently, TdP risk drug use was associated with less likelihood of the presenting rhythm being shockable (odds ratio [OR] = 0.63, 95% confidence interval [CI]:0.58–0.69) and ROSC (OR = 0.73, 95% CI:0.66–0.80).

Conclusion

TdP risk drug use increased in the time leading up to OHCA and was associated with reduced likelihood of presenting with a shockable rhythm and ROSC in an all-comer OHCA setting. However, patients in TdP risk drug treatment were older and more comorbid than patients not in treatment.

中文翻译：

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在院外心脏骤停和可电击节律和自主循环恢复的患者中使用尖端扭转型室性心动过速风险药物：一项全国性研究

目标

使用某些药物治疗会增加发生恶性心律失常的风险（例如尖端扭转型室速 [TdP]）。因此，我们检查了院外心脏骤停 (OHCA) 之前的总体 TdP 风险药物使用情况，以及与可电击节律和自主循环恢复 (ROSC) 的可能关联。

方法

根据 www.CredibleMeds.org确定了来自丹麦心脏骤停登记处（2001-2014 年）和 TdP 风险药物使用的 ≥18 岁的心脏起源 OHCA 的患者。与 TdP 风险药物使用相关的因素以及使用如何影响可电击节律和 ROSC 由多变量逻辑回归确定。

结果

我们确定了 27,481 名心源性 OHCA 患者（中位年龄：72 岁 [四分位距 62.0, 80.0 岁]）。共有 37% 的人在 OHCA 前 0-30 天接受 TdP 风险药物治疗，而 33% 在 OHCA 前 61-90 天接受 TdP 风险药物治疗（p  < 0.001）。最常用的 TdP 风险药物是西酞普兰 (36.1%) 和罗红霉素 (10.7%)。与未接受治疗的患者相比，接受 TdP 风险药物治疗的患者年龄更大（75 岁 vs 70 岁）且合并症更多。随后，TdP 风险药物使用与呈现节律可电击的可能性较小（优势比 [OR] = 0.63，95% 置信区间 [CI]：0.58-0.69）和 ROSC（OR = 0.73，95% CI：0.66）相关–0.80)。

结论

TdP 风险药物使用在导致 OHCA 的时间增加，并且与在全来者 OHCA 环境中出现可电击节律和 ROSC 的可能性降低有关。然而，接受 TdP 风险药物治疗的患者比未接受治疗的患者年龄更大且合并症更多。