Survivors of Out-of-Hospital Cardiac Arrest

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 (453%o), and 181 patients (54.7%o) received pharmacological and/or surgical therapy alone. Left ventricular ejection fraction was 35.2±16.6% in defibrillator recipients and 453±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 1and 5-year probabilities of survival free of cardiac mortality in patients with left ventricular ejection fraction ofless than 0.40 were 943% and 69.6%o with a defibrillator and 82.1% and 453% without a defibrillator, respectively. For patients with left ventricular ejection fraction of 0.40 or more, the 1and 5-year probabilities of survival free of cardiac mortality were 97.7% and 94.61% with a defibrillator and 95.4% and 86.9%,o 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. (Circulation. 1993;88:1083-1092.)