Role of coronary artery surgery in patients surviving unexpected cardiac arrest.
During the past 3-1/2 years, 101 of 199 patients who were successfully resuscitated by fire rescue squads in the community after unexpected cardiac arrest (documented ventricular fibrillation--VF) were admitted to the hospital. Forty-two of these patients ultimately were discharged from the hospital. However, the intermediate and long-term results were disappointing, for their mean survival after discharge was only 12.7 months. Sudden deaths (recurrent unexpected VF) occurred during the first 12 months after discharge in 28 percent of the patients surviving the initial hospitalization. Among the survivors of sudden and unexpected VF (i.e., survivors of the initial hospitalization), 16 patients who had had pre-existing symptoms of coronary heart disease had hemodynamic and coronary angiographic studies. Of these, 11 were considered surgical candidates. This report concerns the follow-up results in these patients with particular emphasis on the eight patients who accepted surgery and had myocardial revascularization. Five patients had moderate hemodynamic abnormalities, but none had had an acute myocardial infarction at the time of the initial arrest. The group of eight patients had a total of 18 vein graft bypasses performed. The significant findings is that all eight survived operation, and there was one late death at 10 months. The remaining patients are alive at 14 to 34 months, and six are free of symptoms. Despite patent vein grafts, one patient has had a second serious arrhythmia. It is concluded that surgical intervention can be done safely and may decrease the high posthospitalization, recurrent arrest, and mortality rates in selected survivors of unexpected cardiac arrest. It is concluded further that all patients sustaining an unexpected arrest should have postarrest coronary catheterization and angiography, and all patients should be on antiarrhythmic agents whether or not they receive myocardial revascularization.
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000517:prevention & control; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications*; D003645:Death, Sudden; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D012008:Recurrence
D000889:Anti-Arrhythmia Agents