Results of treatment methods in cardiac arrest following coronary artery bypass grafting.
OBJECTIVE
Emergency re-revascularization and invasive/noninvasive interventions in intensive care unit (ICU) are two main treatment methods in cardiac arrest following coronary artery bypass grafting (CABG). We evaluated the short- and long-term consequences of these two methods and discussed the indications for re-revascularization.


METHODS
Between 1998 and 2004, a total of 148 CABG patients, who were complicated with cardiac arrest, were treated with emergency re-revascularization (n = 36, group R) and ICU procedures (n = 112, group ICU). Re-revascularizations are mostly blind operations depending on clinical/hemodynamic criteria. These are: no response to resuscitation, recurrent tachycardia/fibrillation, and severe hemodynamic instability after resuscitation. Re-angiography could only be performed in 3.3% of the patients. Event-free survival of the groups was calculated by the Kaplan-Meier method. Events are: death, recurrent angina, myocardial infarction, functional capacity, and reintervention.


RESULTS
Seventy percent of patients, who were complicated with cardiac arrest, had perioperative myocardial infarction (PMI). This rate was significantly higher in group R (p = 0.013). The major finding in group R was graft occlusion (91.6%). During in-hospital period, no difference was observed in mortality rates between the two groups. However, hemodynamic stabilization time (p = 0.012), duration of hospitalization (p = 0.00006), and mechanical support use (p = 0.003) significantly decreased by re-revascularization. During the mean 37.1 +/- 25.1 months of follow-up period, long-term mortality (p = 0.03) and event-free survival (p = 0.029) rates were significantly in favor of group R.


CONCLUSIONS
Better short- and long-term results were observed in the re-revascularization group.
Guney
Mehmet R
MR
Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Centre, Istanbul, Turkey.
Ketenci
Bulend
B
Yapici
Fikri
F
Sokullu
Onur
O
Firat
Mehmet F
MF
Uyarel
Hüseyin
H
Yapici
Nihan
N
Cinar
Bayer
B
Demirtas
Murat
M
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003325:Coronary Care Units; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D017202:Myocardial Ischemia / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology