Impact of Blood Pressure Targets in Patients With Heart Failure Undergoing Postresuscitation Care: A Subgroup Analysis From a Randomized Controlled Trial.

IF 7.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Heart Failure Pub Date : 2024-06-01 Epub Date: 2024-06-07 DOI:10.1161/CIRCHEARTFAILURE.123.011437

Johannes Grand, Christian Hassager, Henrik Schmidt, Simon Mølstrøm, Benjamin Nyholm, Laust E R Obling, Martin A S Meyer, Emma Illum, Jakob Josiassen, Rasmus P Beske, Henrik Høigaard Frederiksen, Jordi S Dahl, Jacob E Møller, Jesper Kjaergaard

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引用次数: 0

Abstract

Background: To assess the effect of targeting higher or lower blood pressure during postresucitation intensive care among comatose patients with out-of-hospital cardiac arrest with a history of heart failure.

Methods: The BOX trial (Blood Pressure and Oxygenation Targets After Out-of-Hospital Cardiac Arrest) was a randomized, controlled, double-blinded, multicenter study comparing titration of vasopressors toward a mean arterial pressure (MAP) of 63 versus 77 mm Hg during postresuscitation intensive care. Patients with a history of heart failure were included in this substudy. Pulmonary artery catheters were inserted shortly after admission. History of heart failure was assessed through chart review of all included patients. The primary outcome was cardiac index during the first 72 hours. Secondary outcomes were left ventricular ejection fraction, heart rate, stroke volume, renal replacement therapy and all-cause mortality at 365 days.

Results: A total of 134 patients (17% of the BOX cohort) had a history of heart failure (patients with left ventricular ejection fraction, ≤40%: 103 [77%]) of which 71 (53%) were allocated to a MAP of 77 mm Hg. Cardiac index at intensive care unit arrival was 1.77±0.11 L/min·m^-2 in the MAP63-group and 1.78±0.17 L/min·m^-2 in the MAP77, P=0.92. During the next 72 hours, the mean difference was 0.15 (95% CI, -0.04 to 0.35) L/min·m^-2; P_group=0.22. Left ventricular ejection fraction and stroke volume was similar between the groups. Patients allocated to MAP77 had significantly elevated heart rate (mean difference 6 [1-12] beats/min, P_group=0.03). Vasopressor usage was also significantly increased (P=0.006). At 365 days, 69 (51%) of the patients had died. The adjusted hazard ratio for 365 day mortality was 1.38 (0.84-2.27), P=0.20 and adjusted odds ratio for renal replacement therapy was 2.73 (0.84-8.89; P=0.09).

Conclusions: In resuscitated patients with out-of-hospital cardiac arrest with a history of heart failure, allocation to a higher blood pressure target resulted in significantly increased heart rate in the higher blood pressure-target group. However, no certain differences was found for cardiac index, left ventricular ejection fraction or stroke volume.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099.

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血压目标对接受复苏后护理的心力衰竭患者的影响：一项随机对照试验的分组分析

背景：评估对有心力衰竭病史的院外心脏骤停昏迷患者在复苏后重症监护期间进行高血压或低血压治疗的效果：目的：评估对有心力衰竭病史的院外心脏骤停昏迷患者在复苏后重症监护期间采用较高或较低血压目标的效果：BOX试验（院外心脏骤停后的血压和氧合目标）是一项随机、对照、双盲、多中心研究，比较了在复苏后重症监护期间将血管加压药滴定在63和77毫米汞柱的平均动脉压（MAP）之间的效果。有心力衰竭病史的患者也参与了这项子研究。入院后不久即插入肺动脉导管。对所有纳入研究的患者进行病历审查，评估其是否有心衰病史。主要结果是最初 72 小时内的心脏指数。次要结果为左室射血分数、心率、每搏量、肾脏替代治疗和 365 天的全因死亡率：共有134名患者（占BOX队列的17%）有心力衰竭病史（左室射血分数≤40%的患者：103人[77%]），其中71人（53%）的MAP值为77毫米汞柱。到达重症监护室时，MAP63 组的心脏指数为 1.77±0.11 L/min-m-2 ，MAP77 组为 1.78±0.17 L/min-m-2，P=0.92。在接下来的 72 小时内，平均差异为 0.15（95% CI，-0.04 至 0.35）L/min-m-2；Pgroup=0.22。两组患者的左心室射血分数和每搏量相似。分配到 MAP77 的患者心率明显升高（平均差异为 6 [1-12] 次/分，Pgroup=0.03）。血管加压素的使用量也明显增加（P=0.006）。365天时，69名患者（51%）死亡。365天死亡率的调整危险比为1.38（0.84-2.27），P=0.20，肾脏替代治疗的调整几率比为2.73（0.84-8.89；P=0.09）：对于有心力衰竭病史的院外心脏骤停复苏患者，分配较高的血压目标值会使较高血压目标值组的心率显著增加。然而，在心脏指数、左心室射血分数或每搏容积方面没有发现明显差异：URL：https://www.clinicaltrials.gov；唯一标识符：NCT03141099。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Heart Failure 医学-心血管系统

CiteScore

12.90

自引率

3.10%

发文量

271

审稿时长

6-12 weeks

期刊介绍： Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.