Background

An uncertain proportion of patients with acute coronary syndrome (ACS) also experience out-of-hospital cardiac arrest (OHCA). Predictors of OHCA in ACS remain unclear and vulnerable to selection bias as pre-hospital deceased patients are usually not included.

Methods

Data on patients aged 18–50 years from a percutaneous coronary intervention (PCI) and OHCA registry were combined to identify all patients experiencing OHCA due to ACS (not including those managed medically or who proceeded to cardiac surgery). Clinical, angiographic and forensic details were collated. In-hospital and post-discharge outcomes were compared between OHCA survivors and non-OHCA ACS patients.

Results

OHCA occurred in 6.0% of ACS patients transported to hospital and 10.0% of all ACS patients. Clinical predictors were non-diabetic status (p = 0.015), non-obesity (p = 0.004), ST-elevation myocardial infarction (p < 0.0001) and left main (p < 0.0002) or left anterior descending (LAD) coronary artery (p < 0.0001) as culprit vessel. OHCA patients had poorer in-hospital clinical outcomes, including longer length of stay and higher pre-procedural intubation, cardiogenic shock, major adverse cardiovascular events, bleeding, and mortality (p < 0.0001 for all). At 30 days, OHCA survivors had equivalent cardiac function and return to premorbid independence but higher rates of anxiety/depression (p = 0.029).

Conclusion

OHCA complicates approximately 10% of ACS in the young. Predictors of OHCA are being non-diabetic, non-obese, having a STEMI presentation, and left main or LAD coronary culprit lesion. For OHCA patients surviving to PCI, higher rates of in-hospital complications are observed. Despite this, recovery of pre-morbid physical and cardiac function is equivalent to non-OHCA patients, apart from higher rates of anxiety/depression.

中文翻译：

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预测 50 岁以下急性冠状动脉综合征患者心脏骤停的因素：全州范围内的血管造影和法医结果评估

背景

不确定比例的急性冠状动脉综合征 (ACS) 患者还会经历院外心脏骤停 (OHCA)。ACS 中 OHCA 的预测因子仍不清楚，并且容易受到选择偏倚的影响，因为通常不包括院前死亡患者。

方法

合并来自经皮冠状动脉介入治疗 (PCI) 和 OHCA 登记的 18-50 岁患者的数据，以确定所有因 ACS 发生 OHCA 的患者（不包括接受药物治疗或进行心脏手术的患者）。整理了临床、血管造影和法医细节。比较了 OHCA 幸存者和非 OHCA ACS 患者的住院和出院后结果。

结果

6.0% 被送往医院的 ACS 患者和 10.0% 的所有 ACS 患者发生 OHCA。临床预测因素是非糖尿病状态 (p = 0.015)、非肥胖 (p = 0.004)、ST 段抬高心肌梗死 (p < 0.0001) 和左主干 (p < 0.0002) 或左前降支 (LAD) 冠状动脉 ( p < 0.0001) 作为罪魁祸首。OHCA 患者的住院临床结果较差，包括住院时间较长和术前插管、心源性休克、主要不良心血管事件、出血和死亡率较高（所有 p < 0.0001）。在 30 天时，OHCA 幸存者的心脏功能相当，恢复到病前的独立性，但焦虑/抑郁的发生率更高（p = 0.029）。

结论

OHCA 使大约 10% 的年轻人 ACS 复杂化。OHCA 的预测因素是非糖尿病、非肥胖、有 STEMI 表现以及左主干或 LAD 冠状动脉罪魁祸首病变。对于通过 PCI 存活的 OHCA 患者，观察到较高的院内并发症发生率。尽管如此，除了更高的焦虑/抑郁率之外，病前身体和心脏功能的恢复与非 OHCA 患者相当。