Abstract 12758: Cardiac Arrest After Cardiac Surgery is Associated With High In-Hospital and Long-Term Mortality

Abstract

Introduction: Cardiac arrest is a grave complication after cardiac surgery with a case fatality rate of ~60%. However, the long-term mortality and outcomes of post-operative patients who survived cardiac arrest is less clear. Methods: We examined the mortality and outcomes of 6,979 consecutive patients who underwent cardiac surgery from at the Minneapolis VA Medical Center from 1991 to 2014. Data was collected prospectively. Results: The mean age was 66 ± 9 years, 99% of the patients were male and 72% had coronary artery bypass graft surgery. In total, 182 (2.6%) patients had a cardiac arrest (median 3 days; range 0-39 days) after surgery. Of these, 93 (51%) died during the same hospitalization and an additional 24 (13%) died within 1 year. Mortality at 30-days (51% vs. 1.9%; p <0.0001), at 1-year (64% vs. 6%; p <0.0001), and after 7.5±5.5 years of follow-up (81% vs. 34%; p<0.0001), was higher in those with vs. without cardiac arrest (Figure 1). After adjusting for age, sex, year, and type of surgery, having an in-hospital cardiac arrest was associated with a 4.7 (95% CI 3.9-5.6; p < 0.0001) times higher risk of long-term mortality in the whole cohort, 2.0 (95% CI 1.6-2.7; p < 0.0001) times higher risk among those who survived 30 days after surgery, and 1.3 (95% CI 0.9-1.9; p = 0.14) times higher risk among those who survived 1 year. Independent predictors of death among cardiac arrest patients who were discharged alive include being discharged to a facility (HR 3.97; 95% CI 1.52-10.32; p=0.005) and renal dysfunction (HR 3.35; 95% CI 1.42-7.89; p=0.006). Conclusions: Long-term mortality remains very high in patients who were discharged alive after a postoperative cardiac arrest. Discharge disposition and renal dysfunction may have important prognostic implications in these patients.