NEJM:无ST段抬高心脏骤停后冠状动脉造影时机

2019-04-11 xing.T 网络

由此可见,在院外心脏骤停后已成功复苏并且没有STEMI症状的患者中,在90天总体存活率方面未发现即刻血管造影的策略优于延迟血管造影策略。

缺血性心脏病是院外心脏骤停的主要原因。在没有ST段抬高心肌梗死(STEMI)的情况下,即刻冠状动脉造影和经皮冠状动脉介入治疗(PCI)在心脏骤停后成功复苏患者的治疗中的作用仍然不确定。

近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员进行了一项多中心试验,随机分配了552名患有心脏骤停而无STEMI症状的患者,这些患者接受了即刻冠状动脉造影或延迟至神经恢复后的冠状动脉造影。如果需要,所有患者均接受PCI。该研究的主要终点是90天存活率。次要终点包括90天存活、具有良好的脑功能或轻度或中度残疾、心肌损伤、儿茶酚胺支持持续时间、休克标志物、室性心动过速复发、机械通气持续时间、大出血、急性肾损伤发生、需要肾脏替代治疗、达到目标体温的时间以及重症监护病房出院时的神经系统状态。

在90天时,即刻血管造影组中273名患者中的176名(64.5%)和延迟血管造影组中178名患者中的178名(67.2%)存活(比值比为0.89; 95%置信区间[CI]为0.62至1.27 ; P=0.51)。直接血管造影组的目标温度中位时间为5.4小时,延迟血管造影组为4.7小时(几何平均值比为1.19; 95%CI为1.04至1.36)。在剩余的次要终点中未发现各组之间的显著差异。

由此可见,在院外心脏骤停后已成功复苏并且没有STEMI症状的患者中,在90天总体存活率方面未发现即刻血管造影的策略优于延迟血管造影策略。  

原始出处:

Jorrit S. Lemkes,et al.Coronary Angiography after Cardiac Arrest without ST-Segment Elevation.NEJM.2019.https://www.nejm.org/doi/full/10.1056/NEJMoa1816897

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    2019-04-12 gdsun
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    2019-04-12 hyf035
  5. [GetPortalCommentsPageByObjectIdResponse(id=1423083, encodeId=54ba1423083f8, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447155, encodeId=81a1144e155e0, content=<a href='/topic/show?id=97e1309105d' target=_blank style='color:#2F92EE;'>#冠状动脉造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30910, encryptionId=97e1309105d, topicName=冠状动脉造影)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/RNJfsfhsEic2avjCncr2VWPKViaUUV8QbHGvDicvYf6AiaQxTlhBo1TZBFuZQq80ia2pejj3QwjOy03Hyt1z1b3DQpA/132, createdBy=2e4c5322318, createdName=mhzhuang@stu.e, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1494104, encodeId=c0cb1494104a1, content=<a href='/topic/show?id=3e34949e333' target=_blank style='color:#2F92EE;'>#造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94973, encryptionId=3e34949e333, topicName=造影)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1624410, encodeId=0771162441064, content=<a href='/topic/show?id=f27b16862d9' target=_blank style='color:#2F92EE;'>#ST段#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16862, encryptionId=f27b16862d9, topicName=ST段)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=676820671866, createdName=hyf035, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034783, encodeId=81861034e8387, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Apr 11 11:21:00 CST 2019, time=2019-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364476, encodeId=e1743644e6ac, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Apr 11 08:56:52 CST 2019, time=2019-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364473, encodeId=d08b3644e3fa, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Apr 11 08:27:04 CST 2019, time=2019-04-11, status=1, ipAttribution=)]
    2019-04-11 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1423083, encodeId=54ba1423083f8, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447155, encodeId=81a1144e155e0, content=<a href='/topic/show?id=97e1309105d' target=_blank style='color:#2F92EE;'>#冠状动脉造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30910, encryptionId=97e1309105d, topicName=冠状动脉造影)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/RNJfsfhsEic2avjCncr2VWPKViaUUV8QbHGvDicvYf6AiaQxTlhBo1TZBFuZQq80ia2pejj3QwjOy03Hyt1z1b3DQpA/132, createdBy=2e4c5322318, createdName=mhzhuang@stu.e, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1494104, encodeId=c0cb1494104a1, content=<a href='/topic/show?id=3e34949e333' target=_blank style='color:#2F92EE;'>#造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94973, encryptionId=3e34949e333, topicName=造影)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1624410, encodeId=0771162441064, content=<a href='/topic/show?id=f27b16862d9' target=_blank style='color:#2F92EE;'>#ST段#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16862, encryptionId=f27b16862d9, topicName=ST段)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=676820671866, createdName=hyf035, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034783, encodeId=81861034e8387, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Apr 11 11:21:00 CST 2019, time=2019-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364476, encodeId=e1743644e6ac, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Apr 11 08:56:52 CST 2019, time=2019-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364473, encodeId=d08b3644e3fa, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Apr 11 08:27:04 CST 2019, time=2019-04-11, status=1, ipAttribution=)]
    2019-04-11 深海的鱼

    学习学习学习

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1423083, encodeId=54ba1423083f8, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447155, encodeId=81a1144e155e0, content=<a href='/topic/show?id=97e1309105d' target=_blank style='color:#2F92EE;'>#冠状动脉造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30910, encryptionId=97e1309105d, topicName=冠状动脉造影)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/RNJfsfhsEic2avjCncr2VWPKViaUUV8QbHGvDicvYf6AiaQxTlhBo1TZBFuZQq80ia2pejj3QwjOy03Hyt1z1b3DQpA/132, createdBy=2e4c5322318, createdName=mhzhuang@stu.e, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1494104, encodeId=c0cb1494104a1, content=<a href='/topic/show?id=3e34949e333' target=_blank style='color:#2F92EE;'>#造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94973, encryptionId=3e34949e333, topicName=造影)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1624410, encodeId=0771162441064, content=<a href='/topic/show?id=f27b16862d9' target=_blank style='color:#2F92EE;'>#ST段#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16862, encryptionId=f27b16862d9, topicName=ST段)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=676820671866, createdName=hyf035, createdTime=Fri Apr 12 23:21:00 CST 2019, time=2019-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034783, encodeId=81861034e8387, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Apr 11 11:21:00 CST 2019, time=2019-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364476, encodeId=e1743644e6ac, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Apr 11 08:56:52 CST 2019, time=2019-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364473, encodeId=d08b3644e3fa, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Apr 11 08:27:04 CST 2019, time=2019-04-11, status=1, ipAttribution=)]
    2019-04-11 龙胆草

    学习谢谢分享

    0