Every N R, Fahrenbruch C E, Hallstrom A P, Weaver W D, Cobb L A
Northwest Health Services Research, Harborview Medical Center, Seattle, Washington 98104.
J Am Coll Cardiol. 1992 Jun;19(7):1435-9. doi: 10.1016/0735-1097(92)90599-i.
The effect of coronary bypass surgery on recurrent cardiac arrest was estimated in 265 patients resuscitated from out of hospital cardiac arrest between 1970 and 1988. From this cohort, 85 patients (32%) underwent coronary bypass surgery after recovery from cardiac arrest and 180 patients (68%) were treated medically. A multivariate Cox analysis was used to estimate the effect of coronary bypass surgery on subsequent survival after adjusting for effects of age, prior cardiac history, ejection fraction, year of the event, history of angina, antiarrhythmic drug use and whether the arrest was related to acute myocardial infarction. The use of coronary bypass surgery had a significant effect in reducing the incidence of subsequent cardiac arrest during follow-up study (risk ratio [RR] 0.48, 95% confidence interval [CI] 0.24 to 0.97, p less than 0.04). There was also a trend consistent with a reduction in total cardiac mortality (RR 0.65, 95% CI 0.39 to 1.10, p = 0.10). These findings suggest that coronary bypass surgery may reduce the incidence of sudden death in suitable patients resuscitated from an episode of ventricular fibrillation.
1970年至1988年间，对265例从院外心脏骤停中复苏的患者进行了冠状动脉搭桥手术对复发性心脏骤停影响的评估。在这个队列中，85例患者（32%）在心脏骤停恢复后接受了冠状动脉搭桥手术，180例患者（68%）接受了药物治疗。采用多变量Cox分析来评估冠状动脉搭桥手术在调整年龄、既往心脏病史、射血分数、事件发生年份、心绞痛病史、抗心律失常药物使用情况以及心脏骤停是否与急性心肌梗死相关等因素的影响后，对后续生存的影响。在随访研究中，冠状动脉搭桥手术的使用在降低后续心脏骤停发生率方面有显著效果（风险比[RR] 0.48，95%置信区间[CI] 0.24至0.97，p小于0.04）。在总心脏死亡率降低方面也有一致的趋势（RR 0.65，95% CI 0.39至1.10，p = 0.10）。这些发现表明，冠状动脉搭桥手术可能降低从心室颤动发作中复苏的合适患者的猝死发生率。
