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Estimating outcomes of astronauts with myocardial infarction in exploration class space missions.
MedLine Citation:
PMID:  22303586     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
INTRODUCTION: We estimate likelihood of presenting rhythms and survival to hospital discharge outcome after acute cardiac ischemia with arrhythmia and/or myocardial infarction (AMI) during long-duration space missions (LDSM) using selected terrestrial cohorts in medical literature. Medical scenarios were risk-stratified by coronary artery calcium score (CAC) and Framingham risk factors (FRF).
METHODS: AMI with and without sudden cardiac arrest (SCA) likelihoods and clinically significant rhythm scenarios and associated outcomes in "astronaut-like" cohorts were derived from two prospective trials identified by an evidence-based literature review. Results are presented using an event sequence diagram and event time line. The association of increasing CAC scores and FRF with AMI and SCA outcomes was calculated.
RESULTS: Low AMI likelihoods are estimated in individuals with CAC scores of zero or < 100 and a low number of FRF. Survival rate to hospital discharge after out of hospital SCA in a large urban environment study was 5.2%. EMS-witnessed ventricular tachycardia and/or ventricular fibrillation survival rate of 37.5% represents < 1% of all urban out of hospital AMI, and these patients have a high proportion of known ischemic cardiovascular and pulmonary disease "disqualifying for spaceflight."
DISCUSSION: Multiple factors may be expected to delay or defeat rapid access to "chain of survival" resources during LDSM, lowering survival rates below urban levels of 5.2%. Low CAC and FRF reflect lower risk for AMI events. Zero CAC was associated with the lowest risk of AMI after 3.5 yr of follow-up. Quantifiable incidence and outcome characterization suggests AMI in LDSM outcomes will be relatively independent of in-flight medical resources.
Authors:
David B Gillis; Douglas R Hamilton
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Aviation, space, and environmental medicine     Volume:  83     ISSN:  0095-6562     ISO Abbreviation:  Aviat Space Environ Med     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-06     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7501714     Medline TA:  Aviat Space Environ Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  79-91     Citation Subset:  IM; S    
Affiliation:
University of Texas Medical Branch Galveston, Galveston, TX, USA. dgillis@ix.netcom.com
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