Long-Term Outcomes of Patients Who Had Cardiac Arrest After Cardiac Operations

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• 作者：Kairav Vakil ; MD^a ; ^&lowast ; ; Jessica V. Kealhofer ; MD^a ; ^b ; ^&lowast ; ; ^{voigh022@umn.edu" class="auth_mail" title="E-mail the corresponding author} ; M. Chadi Alraies ; MD^b ; Santiago Garcia ; MD^a ; Edward O. McFalls ; MD^a ; Rosemary F. Kelly ; MD^c ; Herbert B. Ward ; MD ; PhD^c ; Selcuk Adabag ; MD ; MS^a
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：102
• 期：2
• 页码：512-517
• 全文大小：466 K

文摘

Cardiac arrest after cardiac procedures has a case fatality rate of approximately 60%. However, the long-term risk of death and outcomes among survivors of postoperative cardiac arrest is less clear.

Methods

We examined the mortality and outcomes of 6,979 consecutive patients who underwent cardiac operations from 1991 to 2014 in the Minneapolis Veterans Affairs Health Care System.

Results

Cardiac arrest occurred in 182 patients (2.6%) at a median of 3 days (range, 0 to 39 days) after the operation. Of these, 93 (51%) died during the same hospitalization, and an additional 24 (13%) died within 1 year. Mortality at 30 days (51% vs 1.9%; p < 0.0001), at 1 year (64% vs 6%; p < 0.0001), and after a mean follow-up of 7.5 ± 5.5 years (81% vs 34%; p < 0.0001), was higher in those with vs without cardiac arrest. After adjusting for age, sex, year, and type of operation, an in-hospital cardiac arrest was associated with a 4.7-times (95% confidence interval [CI], 3.9 to 5.6; p < 0.0001) higher risk of long-term death in the entire cohort, 2.0-times (95% CI, 1.6 to 2.7; p < 0.0001) higher risk among those who survived 30 days, and 1.3-times (95% CI, 0.9 to 1.9; p = 0.14) higher risk among those who survived 1 year after the operation. Being discharged to a facility (hazard ratio, 3.97; 95% CI, 1.52 to 10.32; p = 0.005) and renal dysfunction (hazard ratio, 3.35; 95% CI, 1.42 to 7.89; p = 0.006) were independent predictors of death amongst cardiac arrest survivors.

Conclusions

Long-term mortality remains high in patients discharged alive after postoperative cardiac arrest. Discharge disposition and renal dysfunction after cardiac arrest have important prognostic implications.