Long-term survival after prehospital sudden cardiac death.

One hundred thirty-nine survivors of prehospital sudden cardiac death were followed after their hospital discharge. Eighty patients were studied with coronary angiography and cardiac catheterization; 34 of these underwent coronary bypass surgery. After a maximum follow-up of 105 months, 89 patients were still alive. The probability of survival at 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years was 88%, 86%, 78%, 70%, 63%, and 59%, respectively. Of the 43 cardiac deaths, 37 (86%) were secondary to documented recurrent ventricular fibrillation or occurred suddenly. Twelve percent of the total population had recurrent ventricular fibrillation in the first year following the initial cardiac arrest, 16% within 2 years, and 22% within 3 years. Of the 37 survivors dying from recurrent ventricular fibrillation, 32% died within the first 3 months following hospital discharge, 46% in the first year, 64% within 2 years, and 78% within the first 3 years. Most survivors were capable of resuming normal activities after hospital discharge. Only 7% demonstrated permanent neurologic impairment. Sixty-eight percent of the patients who were employed at the time of their prehospital sudden cardiac arrest returned to full-time employment. In the subset of 34 surgically treated patients, there have been six (18%) cardiac deaths. Four of these deaths were related to recurrent ventricular fibrillation, with one of these deaths occurring in the immediate postoperative period. The other three deaths related to recurrent ventricular fibrillation occurred 36 months (two deaths) and 49 months following the initial prehospital cardiac arrest.