Long-term follow-up of survivors of prehospital sudden coronary death.

Fifty-two survivors of prehospital sudden coronary death (SCD) were studied with angiography and cardiac catheterization. Coronary bypass surgery (CAB) was performed and combined with medical therapy in 24 patients and 28 patients were treated with medical therapy alone. Severity of coronary artery disease (CAD), left ventricular function, and clinical characteristics are described in the surgical and medical groups. Most patients had at least two-vessel CAD and left ventricular dysfunction was common. Nineteen of the 24 surgical (79%) and 17 of the 28 medical patients (60%) had a primary dysrhythmia without an associated acute myocardial infarction (MI) as the cause of their SCD. After a maximal follow-up of 80 months (mean 38.2 months in surgical group, 32.2 months in medical group), there have been 12 deaths. Eight of the 10 cardiac deaths occurred in patients showed initial SCD was related to ventricular fibrillation (VF) not associated with acute MI. Four of these 10 deaths were in the surgical group and six were in the medical group. Two surgical patients died in the early postoperative period; the other two died from recurrent VF 36 and 48 months after SCD. No perioperative or postsurgical MIs have occurred and only two patients have angina. In the medical group, five of the six deaths were caused by recurrent VF. Twelve patients have symptoms: angina in eight, heart failure in five and myocardial infarction in three. Nine of the 12 surgical patients (75%) who were employed before their SCD are still employed, while seven of 15 medical patients (47%) are employed. We conclude that the majority of survivors of prehospital SCD have severe CAD, although an associated acute MI at the time of SCD is uncommon. Coronary bypass surgery can be successfully performed in many of these patients and most are asymptomatic after surgery. The long-term results appear encouraging, although further studies are necessary to confirm these results.