Predictors of In-Hospital Mortality after Recovered Out-of-Hospital Cardiac Arrest in Patients with Proven Significant Coronary Artery Disease: A Retrospective Study
, , , , , , , oraz | 31 sty 2020
O artykule
Article Category: Research Article
Data publikacji: 31 sty 2020
Zakres stron: 41 - 51
Otrzymano: 30 lis 2019
Przyjęty: 29 sty 2020
DOI: https://doi.org/10.2478/jccm-2020-0006
Słowa kluczowe
© 2020 Maria Trepa, Samuel Bastos, Marta Fontes-Oliveira, Ricardo Costa, André Dias-Frias, André Luz, Vasco Dias, Mário Santos, Severo Torres, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
Fig. 1
Fig. 2
Clinical scores and biochemical data
| Group 1 rOHCA non-survivors n=26 (43.3%) | Group 2 rOHCA survivors n=34 (56.7%) | P value | |
|---|---|---|---|
| GRACE score (mean, std dev) | |||
| admission¥ | 174.8 ± 37.8 | 160.8 ± 32.1 | 0.1# |
| 24-48h¥/μ | 176.2 ± 33.4 | 151.2 ± 31.9 | 0.041# |
| Troponin T (ng/mL)* | |||
| admission¥¥/∞∞ | 6.4±23 | 1.9±4.6 | 0.074 |
| 24h¥¥¥¥/∞∞ | 6.3±9 | 2.8±2.9 | 0.086 |
| C-reactive protein (mg/L)** | |||
| admission∞ | 15.7 ± 49.2 | 18.27 ± 53.2 | 0.6# |
| 24h¥¥¥/∞ | 54.3 ± 54.4 | 57.5 +/- 55.7 | 0.7# |
| Creatinine (mg/dL)*** | |||
| Admission | 1.36 ± 0.53 | 1.32 ± 0.83 | 0.2# |
| 24h-48h¥¥¥ | 1.32 ± 0.74 | 1.25 ± 1.27 | 0.2# |
| Neutrophils (x10^3/μL) | |||
| Admission | 10.1±3.4 | 10±6.1 | 0.9 |
| 24-48h¥¥¥ | 13.5±7.4 | 10.2±3.6 | 0.1 |
| Haemoglobin (g/L) | |||
| Admission | 13.6 ± 2.1 | 14.1 ± 2.0 | 0.2 |
| 24-48h¥¥¥ | 13.8 ± 2.5 | 13.0 ± 1.6 | 0.1 |
| Lactates (mmol/L) | |||
| admissionΣ | 7.9±5.1 | 5.4±4.7 | 0.039 |
| 1-6h¥/Σ | 3.9±3.9 | 2.2±1.5 | 0.040 |
| 24-48h¥¥¥/∞∞∞ | 2.3±1.9 | 1.4±0.8 | 0.084 |
| pH | |||
| admission∞∞ | 7.17 ± 0.18 | 7.27 ± 0.19 | 0.011# |
| 24-48h¥¥¥/Σ | 7.32 ± 0.10 | 7.41 ± 0.05 | <0.001# |
Baseline and clinical characteristics
| Overall n=60 | Group 1 rOHCA non-survivors n=26 (43.3%) | Group 2 rOHCA survivors n=34 (56.7%) | P value | |
|---|---|---|---|---|
| Age in years, mean (std dev) | 62.6 ± 12.1 | 65.5 ± 10.6 | 60.3 ± 12.8 | 0.1 |
| Gender, male | 51 (85.0%) | 22 (84.6%) | 29 (85.3%) | 0.9 |
| Hypertension | 35 (58.3%) | 18 (69.2%) | 17 (50.0%) | 0.1 |
| Smoking | 35 (58.3%) | 12 (46.2%) | 23 (67.6%) | 0.1 |
| Dyslipidemia | 34 (56.7%) | 15 (57.7%) | 19 (55.9%) | 0.9 |
| previous Coronary Artery Disease | 23 (38.3%) | 12 (46.2%) | 11 (32.4%) | 0.3 |
| Previous myocardial Infarction | 19 (31.7%) | 7 (26.9%) | 12 (35.3%) | 0.5 |
| Diabetes | 15 (25.0%) | 11 (42.3%) | 4 (11.8%) | 0.007 |
| Heart Failure | 11 (18.3%) | 6 (23.1%) | 5 (14.7%) | 0.4 |
| pPCI | 10 (16.7%) | 4 (15.4%) | 6 (17.6%) | 0.8 |
| Peripheral vascular disease | 10 (16.7%) | 6 (23.1%) | 4 (11.8%) | 0.2 |
| Obesity | 9 (15.0%) | 4 (15.4%) | 5 (14.7%) | 0.9 |
| pCABG | 7 (11.7%) | 3 (11.5%) | 4 (11.8%) | 1.0 |
| COPD | 4 (6.7%) | 2 (7.7%) | 2 (5.9%) | 0.8 |
| Stroke | 3 (5.0%) | 3 (11.5%) | 0 (0.0%) | 0.042 |
| Means of transport | ||||
| Medical emergency team | 39 (65.0%) | 20 (76.9%) | 19 (55.9%) | 0.1 |
| Location of cardiac arrest | 0.002 | |||
| Public/Private seting | 40 (66.7%) | 23 (88.5%) | 17 (50%) | |
| Hospital premises/Transport | 20 (33.3%) | 3 (11.5%) | 17 (50%) | |
| Time from BLS to ROSC, minutes¥ (std dev) | 17±13.1 | 22.1±11.4 | 13.3±2 | 0.001 |
| Adrenaline pre-ROSC, mg¥ (std dev) | 2.6 ± 2.8 | 3.6 ± 3.0 | 1.8 ± 2.3 | 0.009# |
| New Cardiac Arrest Initial arrest rhythm | 14 (23.3%) | 8 (30.3%) | 6 (17.6%) | 0.2 0.002 |
| VT/VF | 46 (76.7%) | 15 (57.7%) | 31 (91.2%) | |
| PEA/asystole | 14 (23.3%) | 11 (42.3%) | 3 (8.8%) | |
| Chest pain | 24 (40.0%) | 7 (26.9%) | 17 (50.0%) | 0.1 |
| First EKG | ||||
| STEMI | 36 (60.0%) | 15 (57.7%) | 21 (61.8%) | 0.8 |
Imaging and in-hospital complications data
| Group 1 rOHCA non-survivors n=26 (43.3%) | Group 2 rOHCA survivors n=34 (56.7%) | P value | |
|---|---|---|---|
| Cardiac Catheterization | |||
| Multivessel Disease | 20 (76.9%) | 18 (52.9%) | 0.06 |
| Left main disease or anterior descending artery | 3 (11.5%) | 10 (29.4%) | 0.09 |
| Percutaneous coronary intervention | 17 (65.4%) | 26 (76.5%) | 0.3 |
| Failure | 1 (5.9%) | 2 (7.7%) | 0.8 |
| Complete revascularization | 2 (11.8%) | 0 (0.0%) | 0.2* |
| Echocardiogram | |||
| Left ventricle disfunction moderate/severe | |||
| admission¥¥ | 17 (73.9%) | 23 (67.6%) | 0.6 |
| in-hospital evaluation¥¥¥ | 14 (70%) | 22 (64.7%) | 0.7 |
| In-hospital complications | |||
| Persistent hemodynamic instability | 25 (96.2%) | 13 (38.2%) | <0.001 |
| Anoxic brain injury | 15 (57.7%) | 8 (23.5%) | 0.007 |
| Median duration of stay, days (IQR) | 3 (2-6) | 15 (6-22) | <0.001# |
| Median intensive care unit, days (IQR) | 3 (2-6) | 6 (4-12) | 0.1# |
Multivariate regression analysis
| P value | Odds Ratio | |
|---|---|---|
| Hospital Admission Variables | ||
| Low-flow time >12 minutes | 0.006 | 10.9 |
| Lactates >4.95mmol/L | 0.232 | 2.8 |
| pH<7.25 | 0.075 | 4.2 |
| Non-shockable initial rhythm | 0.02 | 6.9 |
| In-Hospital Evolution Variables | ||
| Anoxic brain lesion | 0.056 | 6 |
| Persistent hemodynamic instability | 0.009 | 24 |
| pH <7.35 at 24h | 0.116 | 4.9 |
| Lactates >2mmol/L at 24h | 0.056 | 6.3 |