Abstract 17780: Influence of Cardiac Catheterization and Automated Implantable Cardioverter Defibrillator Placement on Long-Term Cause of Death in Cardiac Arrest Patients Discharged From the Hospital
Introduction: We and others have associated cardiac catheterization (cath) and cardioverter-defibrillator (AICD) implantation with improved long-term survival after cardiac arrest. It is unclear if this is due to a reduced risk of subsequent cardiovascular events or another mechanism.
Hypothesis: We hypothesize that cath and AICD placement are associated with reduced risk of early cardiovascular (CV) mortality after cardiac arrest.
Methods: We included subjects who suffered in- or out-of-hospital cardiac arrest and were treated and discharged from 7 centers in Southwest Pennsylvania. We abstracted demographic and treatment characteristics and linked patients to National Death Index (NDI) records to determine date and primary cause of death. We dichotomized cause of death as CV or NON-CV, and used competing risk regression analysis to test if cath or AICD placement were independently associated with a reduced risk of CV death within 90 days of discharge or during the entire observation period, with and without stratification by initial arrest rhythm (shockable vs non-shockable).
Results: In 987 subjects observed for 2196 person-years (median observation: 550 days IQR: 112 to 1308d), median age was 61 years (IQR 51-72), 60% were male, 54% arrested out-of-hospital, and 48% had a shockable initial rhythm. Cath was performed in 379 (38%) and 76 (8%) underwent AICD placement. There were 53 CV deaths and 113 non-CV deaths in the first 90 days after acute care discharge. Although both cath and AICD placement were associated with a reduction in all-cause mortality, this was due to a reduction in NON-CV death (cath p<0.001, AICD p=0.68) and neither was associated with a reduced risk of CV mortality (cath p=0.27, AICD p=0.18). This did not change when the entire observation period was analyzed, or after stratification by initial rhythm.
Conclusions: Cath and AICD placement are not independently associated with reduced risk of CV mortality after hospital discharge. This suggests that the associated improvement in long-term survival previously reported associated with these interventions is due to other factors such as selection bias, reduced in-hospital mortality or closer post-acute care follow-up.
Author Disclosures: P.J. Coppler: None. D.J. Wallace: Research Grant; Modest; NIH NHLBI-K08-HL122478. C. Dezfulian: Research Grant; Modest; NIH NINDS K08NS069817. J.C. Rittenberger: Honoraria; Modest; CR Bard. C.W. Callaway: None. J. Elmer: Research Grant; Modest; NIH NHLBI 5K12HL109068.
- © 2016 by American Heart Association, Inc.