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Left-sided valvular heart disease and survival in out-of-hospital cardiac arrest: a nationwide registry-based study.

ABSTRACT: Survival in left-sided valvular heart disease (VHD; aortic stenosis [AS], aortic regurgitation [AR], mitral stenosis [MS], mitral regurgitation [MR]) in out-of-hospital cardiac arrest (OHCA) is unknown. We studied all cases of OHCA in the Swedish Registry for Cardiopulmonary Resuscitation. All degrees of VHD, diagnosed prior to OHCA, were included. Association between VHD and survival was studied using logistic regression, gradient boosting and Cox regression. We studied time to cardiac arrest, comorbidities, survival, and cerebral performance category (CPC) score. We included 55,615 patients; 1948 with AS (3,5%), 384 AR (0,7%), 17 MS (0,03%), and 704 with MR (1,3%). Patients with MS were not described due to low case number. Time from VHD diagnosis to cardiac arrest was 3.7 years in AS, 4.5 years in AR and 4.1 years in MR. ROSC occurred in 28% with AS, 33% with AR, 36% with MR and 35% without VHD. Survival at 30 days was 5.2%, 10.4%, 9.2%, 11.4% in AS, AR, MR and without VHD, respectively. There were no survivors in people with AS presenting with asystole or PEA. CPC scores did not differ in those with VHD compared with no VHD. Odds ratio (OR) for MR and AR showed no difference in survival, while AS displayed OR 0.58 (95% CI 0.46-0.72), vs no VHD. AS is associated with halved survival in OHCA, while AR and MR do not affect survival. Survivors with AS have neurological outcomes comparable to patients without VHD.

SUBMITTER: Dejby E

PROVIDER: S-EPMC10403503 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Left-sided valvular heart disease and survival in out-of-hospital cardiac arrest: a nationwide registry-based study.

Dejby Ellen E Bhatt Deepak L DL Skoglund Kristofer K Rawshani Aidin A Omerovic Elmir E Redfors Björn B Myredal Anna A Petursson Petur P Angerås Oskar O Gustafsson Arvid A Isaksén Daniella D Herlitz Johan J Rawshani Araz A

Scientific reports 20230804 1

Survival in left-sided valvular heart disease (VHD; aortic stenosis [AS], aortic regurgitation [AR], mitral stenosis [MS], mitral regurgitation [MR]) in out-of-hospital cardiac arrest (OHCA) is unknown. We studied all cases of OHCA in the Swedish Registry for Cardiopulmonary Resuscitation. All degrees of VHD, diagnosed prior to OHCA, were included. Association between VHD and survival was studied using logistic regression, gradient boosting and Cox regression. We studied time to cardiac arrest, ...[more]

PMID: 37542095

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Project description:ObjectiveThis study aimed to describe the relationship between sex and survival of patients with out-of-hospital cardiac arrest (OHCA) and further investigate the potential impact of female reproductive hormones on survival outcomes, by stratifying the patients into two age groups.MethodsThis retrospective, national population-based observational, case-control study, included Korean OHCA data from January 1, 2009, to December 31, 2016. We used multiple logistic regression with propensity score-matched data. The primary outcome was survival-to-discharge.ResultsOf the 94,160 patients with OHCA included, 34.2% were women. Before propensity score matching (PSM), the survival-to-discharge rate was 5.2% for females and 9.1% for males, in the entire group (OR 0.556, 95% CI [-0.526-0.588], P<0.001). In the reproductive age group (age 18-44 years), the survival-to-discharge rate was 14% for females and 15.6% for males (OR 0.879, 95% CI [0.765-1.012], P = 0,072) and in the post-menopause age group (age ≥ 55 years), the survival-to-discharge rate was 4.1% for females and 7% for males (OR 0.562, 95% CI [0.524-0.603], P<0.001). After PSM (28,577 patients of each sex), the survival-to-discharge rate was 5.4% for females and 5.4% for males (OR, 1.009 [0.938-1.085], P = 0.810). In the reproductive age group, the survival-to-discharge rate was 14.5% for females and 11.5% for males (OR 1.306, 95% CI [1.079-1.580], P = 0.006) and in the post-menopause age group, the survival-to-discharge rate was 4.2% for females and 4.6% for males (OR 0.904, 95% CI [0.828-0.986], P = 0.022). After adjustment for confounders, women of reproductive age were more likely to survive at hospital discharge. However, there was no statistically significant difference in neurological outcome (OR 1.238, 95% CI [0.979-1.566], P = 0.074).ConclusionsFemales of reproductive age had a better chance of survival when matched for confounding factors. Further studies using sex hormones are needed to improve the survival rate of patients with OHCA.

Project description:BACKGROUND:Post-resuscitation hemodynamic instability following out-of-hospital cardiac arrest (OHCA) may occur from myocardial dysfunction underlying cardiogenic shock and/or inflammation-mediated distributive shock. Distinguishing the predominant shock subtype with widely available clinical metrics may have prognostic and therapeutic value. METHODS:A two-hospital cohort was assembled of patients in shock following OHCA. Left ventricular ejection fraction (LVEF) was assessed via echocardiography or cardiac ventriculography within 1 day post arrest and used to delineate shock physiology. The study evaluated whether higher LVEF, indicating distributive-predominant shock physiology, was associated with neurocognitive outcome (primary endpoint), survival, and duration of multiple organ failures. The study also investigated whether volume resuscitation exhibited a subtype-specific association with outcome. RESULTS:Of 162 patients with post-resuscitation shock, 48% had normal LVEF (> 40%), consistent with distributive shock physiology. Higher LVEF was associated with less favorable neurocognitive outcome (OR 0.74, 95% CI 0.58-0.94 per 10% increase in LVEF; p = 0.01). Higher LVEF also was associated with worse survival (OR 0.81, 95% CI 0.67-0.97; p = 0.02) and fewer organ failure-free days (β = - 0.67, 95% CI - 1.28 to - 0.06; p = 0.03). Only 51% of patients received a volume challenge of at least 30 ml/kg body weight in the first 6 h post arrest, and the volume received did not differ by LVEF. Greater volume resuscitation in the first 6 h post arrest was associated with favorable neurocognitive outcome (OR 1.59, 95% CI 0.99-2.55 per liter; p = 0.03) and survival (OR 1.44, 95% CI 1.02-2.04; p = 0.02) among patients with normal LVEF but not low LVEF. CONCLUSIONS:In post-resuscitation shock, higher LVEF-indicating distributive shock physiology-was associated with less favorable neurocognitive outcome, fewer days without organ failure, and higher mortality. Greater early volume resuscitation was associated with more favorable neurocognitive outcome and survival in patients with this shock subtype. Additional studies with repeated measures of complementary hemodynamic parameters are warranted to validate the clinical utility for subtyping post-resuscitation shock.

Dataset Information

Left-sided valvular heart disease and survival in out-of-hospital cardiac arrest: a nationwide registry-based study.

Publications

Left-sided valvular heart disease and survival in out-of-hospital cardiac arrest: a nationwide registry-based study.

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