立即 vs 延迟冠状动脉血管学在心脏骤停后没有ST段升高:COACT随机试验的5年结果
Eva M Spoormans1, Gladys N Janssens1, Nina W van der Hoeven1
1Department of Cardiology, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.
Journal of the American College of Cardiology
|February 4, 2026
概括
医院外心脏骤停患者的五年生存率是相似的,无论冠状动脉血管造影是立即的还是延迟的. 这项研究发现,对于心脏骤停的幸存者来说,这两种策略之间的结果没有显著差异.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 临床试验 临床试验
背景情况:
- 医院外心脏骤停 (OHCA) 是一个重大的全球健康挑战.
- 心脏骤停后冠状动脉血管学 (COACT) 试验以前在没有ST段升高的OHCA患者中,没有发现立即与延迟血管学90天生存率的差异.
- 以前缺乏比较这些策略的长期生存数据.
研究的目的:
- 评估OHCA患者的即时与延迟冠状动脉血管学对5年生存的影响.
- 评估初始可冲击节律且自发循环恢复后没有ST段升高的患者的结果.
主要方法:
- 一个随机的,开放的,多中心的试验 (COACT),比较即时和延迟的冠状动脉血管学.
- 通过电话采访,对514名没有ST段升高的OHCA患者进行了5年的随访.
- 二级终点包括心肌梗塞,重复复血管化,心力衰竭住院治疗和除器冲击.
主要成果:
- 在5年的随访中,即时血管造影组中的54.8%的患者和延迟血管造影组中的51.8%的患者还活着 (HR:0.95;95%CI:0.74-1.23)
- 探索性分析表明,在延迟组 (HR:0.56;95%CI:0.32-0.97) 中,在90天后存在潜在的生存益处,尽管其意义尚不确定.
- 心肌梗塞,心力衰竭住院和重血管化的发生率在两组之间没有差异.
结论:
- 在没有ST段升高的OHCA患者中,即时和延迟冠状动脉血管学策略之间的五年生存率相似.
- 对于这两种策略,没有明确的短期或长期的益处或危害被确定.
- 在探索性分析中观察到的晚期生存益处需要谨慎,可能是由于偶然.
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