Who leaves the hospital without a defibrillator after a sudden cardiac arrest? - 06/01/20
Résumé |
Introduction |
Implantable Cardioverter Defibrillator (ICD) in sudden cardiac arrest (SCA) is indicated in non-reversible cardiac causes. A systematic description of SCA survivors discharged without an ICD has not been undertaken thus far.
Purpose |
We aimed to describe the frequency, characteristics and etiologies of SCA survivors discharged without an ICD.
Methods |
In this prospective ongoing multicentre community-based study (6.7 million inhabitants), data from all SCA cases alive at hospital discharge, over a 5-year period, were analyzed with a specific focus on survivors. All medical records were reviewed by two cardiologists to identify underlying mechanisms and ascertain etiologies.
Results |
Among the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 717 survivors at hospital discharge fulfilled definition for cardiac SCA. Among them, 247 patients (34.5%) received an ICD and 468 (65.4%) did not. Compared to the ICD group, the group without ICD were older (58.9 vs. 52.6 years, P<0.001). Main etiologies were acute coronary syndrome (ACS) (397, 84.8%), chronic CAD (28, 6.0%), structural non-ischemic heart disease (31, 6.6%) and non-structural heart disease (12, 2.6%). Among survivors with ACS, 93.6% (397 out of 424) were discharged without an ICD and 18 of those were due to coronary spasm (representing 75% of coronary spasm related-SCAs survivors), including three refractory spasms despite pharmacological therapy. Factors independently associated with ICD non-implantation in ACS were the absence of personal CAD history (OR 2.86, CI95% 0.19–6.67, P=0.014) and immediate angioplasty at admission (OR 2.77, CI95% 1.02–6.78, P=0.033).
Conclusions |
Almost two third of SCA survivors were discharged without an ICD; while this was largely related to ACS and coronary stenting, some cases of chronic CAD as well as drug refractory coronary spasm in this population may represent lost opportunity, warranting further studies addressing this specific issue.
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Vol 12 - N° 1
P. 106 - janvier 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.