Abstract 43: Comparative Study of Survival After In-Hospital Cardiac Arrest in Patients with Chagas Cardiomyopathy and Idiopathic Dilated Cardiomyopathy
INTRODUCTION: Chagas Cardiomipathy, among all causes of cardiac insufficiency, appears to be what brings the worst prognosis. The evolution of these patients after in-hospital cardiac arrest is not adequately evaluated in the medical literature.
METHODS: To this propose, from April 2004 to June 2008, Utstein-style data, were prospectively collected from 1027 consecutive in-patient adult index cardiac arrests in an observational, single-center study at a tertiary cardiac care hospital. Of them, 715 (77%) patients performed echocardiograms during admission or until three months pre arrest. We compare the evolution of hospital patients with moderate or severe systolic dysfunction (LVEF <45%) and diagnosis of Chagas Cardiomyopathy (74 patients) and Idiopathic Dilated Cardiomyopathy (74 patients), by univariate and multivariate (logistic regression). The primary end-point was survival to discharge. Secondary outcomes were return of spontaneous circulation for more than 20 minutes, 24-hour survival after cardiac arrest, and discharged with satisfactory neurological evaluation, defined as cerebral performance category 1 or 2.
RESULTS: Survival to discharge was 15% in patients with Idiopathic Dilated Cardiomyopathy compared with 4% in patients with Chagas Cardiomyopathy (after logistic regression; “odds ratio” adjusted = 0.89, 95% CI, 0.09 to 0.907, P <0.001). Another factor associated with lower hospital survival was use of atropine during resuscitation. The rhythm of VF /VT pulseless as the initial rhythm of arrest was associated with higher hospital survival. Both groups did not differ regarding return of spontaneous circulation (54% vs. 58%, P = 0.468), 24-hour survival (39% vs. 41 %, P =0.550), or survival with CPC 1 or 2 (100% vs. 91%, P =0.660).
CONCLUSION: As hypnotized, Chagas Cardiomiopathy was associated with lower rates of survival to hospital discharge, despite similar rates of sustained return of spontaneous circulation and 24-hour survival post-arrest. Peculiarities of Chagas Cardiomyopathy associated with myocardial dysfunction, hyperadrenergic state, postresuscitation inflammatory response seem to contribute strongly to this development more unfavorable.
- © 2012 by American Heart Association, Inc.