Mangi Abeel A, Boeve Theodore J, Vlahakes Gus J, Akins Cary W, Hilgenberg Alan D, Ruskin Jeremy N, McGovern Brian M, Torchiana David F
Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Ann Thorac Surg. 2002 Nov;74(5):1510-6. doi: 10.1016/s0003-4975(02)04086-9.
Patients who survive out-of-hospital cardiac arrest are at high risk for recurrent arrest. Coronary artery bypass grafting (CABG) confers a survival advantage, but it is unclear whether antiarrhythmic drugs or an implanted defibrillator confer added benefit. This study was designed to determine predictors for further treatment, survival, and therapeutic internal cardiac defibrillator (ICD) discharge in this patient population.
One hundred and eight patients undergoing CABG after out-of-hospital cardiac arrest were identified over a 12-year period. Case records were retrospectively reviewed. Follow-up was obtained and predictors of outcome events were analyzed.
Fifty-four (50%) patients underwent CABG only. Fifty-four received additional treatment that included ICD placement in 23 (21%), antiarrhythmic medications in 19 (18%), or both in 12 (11%). Predictors of ICD placement included left ventricular ejection fraction (LVEF) less than 40% and perioperative intraaortic balloon counterpulsation. ICD or medical management increased survival in patients with LVEF <40%. Predictors of increased mortality included age >65 years, Cleveland Severity Score >8, and female gender. Predictors of therapeutic ICD discharge included age >65 years, reoperative CABG, LVEF <40%, and positive postoperative electrophysiological (EP) study. No patient with a negative postoperative EP study received an ICD, and none suffered sudden cardiac death during follow-up.
Patients with coronary artery disease anatomically suitable for CABG who survive an acute out-of-hospital cardiac arrest should undergo EP testing after CABG. Approximately half of these patients are adequately treated by CABG alone. The remainder may benefit from ICD placement or medical antiarrhythmic management.
院外心脏骤停幸存者再次发生心脏骤停的风险很高。冠状动脉旁路移植术（CABG）可带来生存优势，但目前尚不清楚抗心律失常药物或植入式除颤器是否能带来额外益处。本研究旨在确定该患者群体进一步治疗、生存及治疗性体内心脏除颤器（ICD）放电的预测因素。
在12年期间确定了108例院外心脏骤停后接受CABG的患者。回顾性审查病例记录。进行随访并分析结局事件的预测因素。
54例（50%）患者仅接受了CABG。54例接受了额外治疗，其中23例（21%）植入了ICD，19例（18%）使用了抗心律失常药物，12例（11%）两者都使用了。ICD植入的预测因素包括左心室射血分数（LVEF）低于40%和围手术期主动脉内球囊反搏。ICD或药物治疗可提高LVEF<40%患者的生存率。死亡率增加的预测因素包括年龄>65岁、克利夫兰严重程度评分>8和女性。治疗性ICD放电的预测因素包括年龄>65岁、再次手术CABG、LVEF<40%和术后电生理（EP）研究阳性。术后EP研究阴性的患者均未接受ICD，且随访期间均未发生心源性猝死。
解剖结构适合CABG且在急性院外心脏骤停后存活的冠心病患者，应在CABG后进行EP测试。这些患者中约一半仅通过CABG即可得到充分治疗。其余患者可能受益于ICD植入或药物抗心律失常治疗。
