Circulation, Vol 88, 1083-1092, Copyright © 1993 by American Heart Association
AC Powell, T Fuchs, DM Finkelstein, H Garan, DS Cannom, BA McGovern, E Kelly, GJ Vlahakes, DF Torchiana and JN Ruskin
BACKGROUND. Survivors of out-of-hospital cardiac arrest not associated with
acute myocardial infarction are at high risk for recurrent cardiac arrest
and sudden cardiac death. The impact of the implantable
cardioverter-defibrillator on long-term prognosis in these patients is
uncertain. METHODS AND RESULTS. Three hundred thirty-one survivors of
out-of-hospital cardiac arrest (age, 56 +/- 13.7 years) underwent
electrophysiologically guided therapy. Implantable defibrillators were
placed in 150 patients (45.3%), and 181 patients (54.7%) received
pharmacological and/or surgical therapy alone. Left ventricular ejection
fraction was 35.2 +/- 16.6% in defibrillator recipients and 45.3 +/- 18.2%
in nondefibrillator patients. Median patient follow-up was 24 months in the
defibrillator group and 46 months in the nondefibrillator group. In a
proportional hazards model, the independent predictors of total cardiac
mortality were left ventricular ejection fraction of less than 0.40
(relative risk, 4.55; 95% confidence interval, 2.44 to 8.33; P = .0001),
absence of an implantable defibrillator (relative risk, 2.70; confidence
interval, 1.41 to 5.00; P = .017), and persistence of inducible sustained
ventricular tachycardia (relative risk, 1.84; 95% confidence interval, 0.97
to 3.49; P = .045). The 1- and 5-year probabilities of survival free of
cardiac mortality in patients with left ventricular ejection fraction of
less than 0.40 were 94.3% and 69.6% with a defibrillator and 82.1% and
45.3% without a defibrillator, respectively. For patients with left
ventricular ejection fraction of 0.40 or more, the 1- and 5- year
probabilities of survival free of cardiac mortality were 97.7% and 94.6%
with a defibrillator and 95.4% and 86.9% without a defibrillator,
respectively. CONCLUSIONS. In survivors of out-of-hospital cardiac arrest,
the implantable defibrillator is associated with a reduction in cardiac
mortality, particularly in patients with impaired left ventricular
function.
ARTICLES
Influence of implantable cardioverter-defibrillators on the long-term prognosis of survivors of out-of-hospital cardiac arrest
Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston 02114.
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