ABSTRACT
INTRODUCTION: Most cardiac arrests in adults are related to coronary artery disease (CAD), and the role of early invasive cardiology procedures remains unclear. AIMS: We investigated the prognosis for patients hospitalized for out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who were referred within 24 hours to a tertiary cardiology department, with a focus on the role of early coronary angiography (CA) and percutaneous coronary intervention (PCI). METHODS: This was an observational, single-center study using retrospective and prospective cohorts. Consecutive patients hospitalized for OHCA or IHCA and referred within 24 hours to a cardiology department were included in the study. Survival until hospital discharge was the primary outcome. RESULTS: One hundred and forty-eight patients aged 71 (14) years were included, 68 hospitalized for OHCA, and 80 patients after IHCA. Overall, in-hospital survival in the study group was 45% (66/148). In a multivariable logistic regression model, independent predictors of death were ejection fraction (EF) ≤30% (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.69-10.03), blood oxygen saturation (SpO2) ≤90% (OR, 2.77; 95% CI, 1.19-6.46), non-ST-segement elevation myocardial infarction (NSTEMI) (OR, 2.71; 95% CI, 1.02-7.21). The risk of death was lower in patients who underwent early CA (OR, 0.28; 95% CI, 0.1-0.74) or received at least one defibrillation (OR, 0.11; 95% CI, 0.05-0.27), even after adjustment for other factors. CONCLUSIONS: In this series from a tertiary cardiac center, patients who underwent early CA had improved outcomes after cardiac arrest. In the multivariable logistic regression model, lower SpO2, lower EF, and NSTEMI were independent risk factors of death, whereas early CA and initial shockable rhythm improved survival.
Subject(s)
Cardiopulmonary Resuscitation , Non-ST Elevated Myocardial Infarction , Out-of-Hospital Cardiac Arrest , Percutaneous Coronary Intervention , Adult , Humans , Coronary Angiography/methods , Percutaneous Coronary Intervention/adverse effects , Retrospective Studies , Prospective Studies , Non-ST Elevated Myocardial Infarction/complications , Out-of-Hospital Cardiac Arrest/therapy , SurvivorsABSTRACT
AIMS: Endothelial dysfunction in chronic heart failure (CHF) contributes to vasoconstriction. Underlying atherosclerosis may increase vascular abnormalities in ischaemic CHF. We aimed to compare flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) of the brachial artery between patients with ischaemic and non-ischaemic CHF. METHODS AND RESULTS: A total of 57 patients with systolic CHF participated in the study (mean age 59 +/- 8 years, 81% male). Patients were in stable NYHA class II (40 patients, 70%) and III (17 patients, 30%). Ischaemic aetiology of CHF was confirmed by coronary angiography in 34 (60%) patients and ruled out in 23 (40%). Flow-mediated dilation and NMD of the brachial artery was assessed by high-resolution ultrasound. Endothelium-dependent vasodilation was markedly reduced in patients with ischaemic CHF compared with those with non-ischaemic aetiology of CHF-mean absolute change in artery diameter (Deltad) 0.09 +/- 0.07 mm in ischaemic group vs. 0.18 +/- 0.07 mm in non-ischaemic (P < 0.0001). Nitroglycerin-mediated vasodilation was also significantly different-Deltad = 0.14 +/- 0.06 mm in ischaemic vs. 0.31 +/- 0.10 mm in non-ischaemic CHF (P < 0.0001). CONCLUSION: Endothelium-dependent and -independent vascular response is more attenuated in ischaemic than in non-ischaemic CHF.
Subject(s)
Brachial Artery/pathology , Endothelium, Vascular , Heart Failure , Myocardial Ischemia , Vasoconstriction , Vasodilation , Case-Control Studies , Disease Progression , Female , Humans , Male , Middle Aged , Muscle, SmoothABSTRACT
Prevention and treatment of atherosclerosis is an important priority. Measurement of endothelial function has been reported as a useful tool for atherosclerosis research. Endothelium appear to integrate the injury of commonly known risk factors and others, genetic and environmental as yet undiscovered. The assessment of endothelium-dependent vasodilation has emerged as indicator of endothelial health. Invasive methods examine coronary or brachial artery vasomotion in response to infusion of acetylcholine. Noninvasive ultrasound assessment of flow-mediated vasodilation (FMD) of peripheral artery is more often used. However, despite its wide-spread use, there are technical and interpretive limitations of this technique. Recent studies have shown that the severity of endothelial dysfunction relates to cardiovascular risk. Endothelial function might be also used to monitor the effectiveness of risk reduction therapy. This article will review the growing literature in an effort to evaluate methods of assessment of endothelial function and its clinical utility.
