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Bellut H, Guillemet L, Bougouin W, Charpentier J, Ben Hadj Salem O, Llitjos JF, Paul M, Valade S, Spagnolo S, Lamhaut L, Chiche JD, Marijon E, Pène F, Varenne O, Mira JP, Dumas F, Cariou A. Early recurrent arrhythmias after out-of-hospital cardiac arrest associated with obstructive coronary artery disease: Analysis of the PROCAT registry. Resuscitation 2019; 141:81-87. [PMID: 31185259 DOI: 10.1016/j.resuscitation.2019.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE After out-of-hospital cardiac arrest (OHCA) associated with obstructive coronary artery disease (CAD), the risk of recurrence during the early period is unclear and the indication for anti-arrhythmic treatment is debated. We assessed the incidence and predisposing factors for severe cardiac arrhythmias in this population. DESIGN Retrospective study in a cardiac arrest center. SETTINGS The primary endpoint was the occurrence of major cardiac arrhythmias from hospital admission to intensive care unit (ICU) discharge in patients admitted after an OHCA associated with obstructive CAD. A major arrhythmia was defined as any arrhythmic event (auricular or ventricular) associated with cardiac arrest recurrence and/or severe arterial hypotension. Secondary outcomes were time from ICU admission to arrhythmia occurrence and all-cause in-ICU mortality. Risk factors for recurrence of a major arrhythmia were assessed using multivariate analysis. PATIENTS We included all consecutive OHCA patients resuscitated from ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as initial rhythm associated with obstructive CAD, and who had a successful primary percutaneous coronary intervention. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Among 256 patients, a major arrhythmia occurred in 29 (11.3%), within the first 24 h in 79.3% of cases and were mostly VF (44.8%). Mortality rate was significantly increased in patients with major arrhythmia recurrence (69% vs 41%; p = 0.006). Factor significantly associated with recurrence of severe arrhythmia was male gender (OR 0.32 [0.12-0.92]; p = 0.034). Treatment with prophylactic anti-arrhythmic in the ICU was not associated with a change in the risk of recurrence (OR 0.85 [0.21-3.65], p = 0.82). CONCLUSION An early recurrence of major arrhythmia was observed in more than 10% of post-cardiac arrest patients. These events happened mostly within the first 24 h. The interest of prophylactic anti-arrhythmic treatment remains to be evaluated in this population.
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Affiliation(s)
- Hugo Bellut
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France
| | - Lucie Guillemet
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France.
| | - Wulfran Bougouin
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | | | - Omar Ben Hadj Salem
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Jean-François Llitjos
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Marine Paul
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Sandrine Valade
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France
| | - Shirley Spagnolo
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France
| | - Lionel Lamhaut
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; SAMU 75, Necker Hospital (APHP), Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | - Jean-Daniel Chiche
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Eloi Marijon
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Cardiology Department, European Georges Pompidou Hospital (APHP), Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Olivier Varenne
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Cardiology Department, Cochin Hospital (APHP), Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Florence Dumas
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Emergency Department, Cochin Hospital (APHP), Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
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Zhang JW, Zhou YJ. Association of silent hypoglycemia with cardiac events in non-diabetic subjects with acute myocardial infarction undergoing primary percutaneous coronary interventions. BMC Cardiovasc Disord 2016; 16:75. [PMID: 27112137 PMCID: PMC4845485 DOI: 10.1186/s12872-016-0245-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 04/14/2016] [Indexed: 12/22/2022] Open
Abstract
Background Some studies have shown that hypoglycemic episodes in diabetic patients might be associated with increased cardiovascular events. It is not clear whether episodes of silent hypoglycemia had greater prognostic value on cardiac events compared with normoglycemia or hyperglycemia in non-diabetic patients, so the aim of this study was to investigate the association of silent hypoglycemia and cardiac events in non-diabetic patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (p-PCI). Methods We enrolled non-diabetic patients with STEMI who underwent p-PCI and whose clinical and laboratory data were collected. Interstitial glucose values were recorded using a continuous glucose monitoring system (CGMS), and Holter monitoring was recorded for 3 days in parallel. Cardiac ischemia and ventricular arrhythmia was evaluated. Results Based on the inclusion and exclusion criteria, we enrolled 164 STEMI patients undergoing p-PCI for final analysis. A total of 280 episodes of silent hypoglycemia (CGMS glucose <70 mg/dl) were recorded. Episodes of silent cardiac ischemia were recorded in 50 of 280 hypoglycemic episodes. The incidence of silent cardiac ischemia during hypoglycemia was significantly higher than the incidence during both hyperglycemia and normoglycemia(P < 0.01). Moreover, we found a significantly higher frequency of ventricular extrasystoles (VESs) or nonsustained ventricular tachycardias (NSVTs) in patients with silent hypoglycemia. The average number of events of silent cardiac ischemia was also significantly increased in the silent hypoglycemia group (0.91 ± 0.82 vs. 0.35 ± 0.54, P < 0.01) compared with either hyperglycemia or normoglycemia group. Conclusions Hypoglycemia was frequent and most of the time asymptomatic in non-diabetic patients with STEMI undergoing p-PCI. Silent hypoglycemia was associated with silent cardiac ischemia. STEMI patients with silent hypoglycemia had a significantly higher frequency of VESs or NSVTs.
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Affiliation(s)
- Jian-Wei Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, the Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, 100029, China
| | - Yu-Jie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, the Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, 100029, China.
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