Long-Term Outcomes of Patients Who Had Cardiac Arrest After Cardiac Operations.
BACKGROUND
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.
Division of Cardiology, Veterans Affairs Health Care System, Minneapolis, Minnesota.
Kairav
K
Vakil
Division of Cardiology, Veterans Affairs Health Care System, Minneapolis, Minnesota; Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: voigh022@umn.edu.
Jessica V
JV
Kealhofer
Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
M Chadi
MC
Alraies
Division of Cardiology, Veterans Affairs Health Care System, Minneapolis, Minnesota.
Santiago
S
Garcia
Division of Cardiology, Veterans Affairs Health Care System, Minneapolis, Minnesota.
Edward O
EO
McFalls
Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Rosemary F
RF
Kelly
Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Herbert B
HB
Ward
Division of Cardiology, Veterans Affairs Health Care System, Minneapolis, Minnesota.
Selcuk
S
Adabag
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors