Time-dependent risk of and predictors for cardiac arrest recurrence in survivors of out-of-hospital cardiac arrest with chronic coronary artery disease.

Abstract

One hundred one consecutive patients with chronic coronary artery disease who had survived out-of-hospital cardiac arrest in the absence of acute myocardial infarction underwent electrophysiologic evaluation and were followed prospectively. Ventricular tachyarrhythmias were inducible in 76 patients (75%) in the control state and were suppressed by antiarrhythmic drugs or surgery in 32 of the 76 patients (42%). During a mean follow-up of 27 months, cardiac arrest recurred in 21 patients: in two of the 25 patients in whom ventricular tachyarrhythmias were not inducible in the control state, three of the 32 in whom inducible ventricular tachyarrhythmias were suppressed after treatment, and 16 of the 44 in whom inducible ventricular tachyarrhythmias could not be suppressed after treatment. Actuarial rate of cardiac arrest recurrence was 11.2% during the first 6 months of follow-up ("high-risk early phase") and then decreased to less than 4% in each subsequent 6-month period. Multivariate Cox proportional hazards analysis identified an ejection fraction less than 35% (p = 0.0013) and persistent inducibility of ventricular tachyarrhythmias (p = 0.0025) as independent predictors of cardiac arrest recurrence for the entire follow-up period. Separate analysis of variables within and after the first 6 months showed that an ejection fraction less than 35% was the strongest predictor for early phase recurrence (p = 0.0078) but had only marginally significant predictive value for late phase recurrence (p = 0.0516). Persistent inducibility of ventricular tachyarrhythmias had no significant predictive value for early phase recurrence (p = 0.1382) but was the strongest predictor for late phase recurrence (p = 0.0061). These data suggest that, in patients with chronic coronary artery disease who survive out-of-hospital cardiac arrest, poor ejection fraction and persistent inducibility of ventricular tachyarrhythmias have a different predictive influence on early and late phase recurrence. Time-dependent risk factor analysis may have great clinical relevance in assessing an individual's changing risk over time.