Estimating outcomes of astronauts with myocardial infarction in exploration class space missions.
BACKGROUND
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."


CONCLUSIONS
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.
University of Texas Medical Branch Galveston, Galveston, TX, USA. dgillis@ix.netcom.com
David B
DB
Gillis
Douglas R
DR
Hamilton
D018480:Astronauts; D017023:Coronary Angiography; D006801:Humans; D016013:Likelihood Functions; D009203:Myocardial Infarction / Q000401:mortality*; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013026:Space Flight; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality; D061205:Vascular Calcification; D014693:Ventricular Fibrillation / Q000401:mortality