Author + information
- Received December 13, 2018
- Revision received March 26, 2019
- Accepted April 18, 2019
- Published online July 15, 2019.
- Amr F. Barakat, MDa,
- Alvin Thalappillil, MDa,
- Dingxin Qin, MDa,
- Adetola Ladejobi, MDa,
- Aditya Bhonsale, MDa,
- Krishna Kancharla, MDa,
- Norman C. Wang, MD, MSa,
- Evan Adelstein, MDb,
- Sandeep Jain, MDa,
- N.A. Mark Estes III, MDa and
- Samir Saba, MDa,∗ (, )@saba_sfs3
- aHeart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- bDivision of Cardiology, Albany Medical College, Albany, New York
- ↵∗Address for correspondence:
Dr. Samir Saba, Cardiac Electrophysiology, Cardiovascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, South Tower E352.6, Pittsburgh, Pennsylvania 15213.
Objectives This study sought to investigate the impact of the neurological status of sudden cardiac arrest (SCA) survivors on implantable cardioverter-defibrillator (ICD) insertion and long-term mortality.
Background The neurological status of SCA survivors may impact the decision to insert an ICD insertion and influence long-term survival.
Methods In 1,433 survivors of SCA between 2002 and 2012, we examined the neurological status immediately after the arrest using the Pittsburgh Cardiac Arrest Category (PCAC) and prior to hospital discharge using the cerebral performance category (CPC) score. Patients were followed up to the endpoints of ICD implantation and all-cause mortality.
Results Over a median follow-up period of 3.6 years, 389 (27%) patients received an ICD, and 674 (47%) died. The PCAC (adjusted hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.69 to 0.90) and CPC (adjusted HR: 0.73; 95% CI: 0.64 to 0.84) scores were highly predictive of the time to ICD insertion and of all-cause mortality (PCAC score, adjusted HR: 1.39; 95% CI: 1.24 to 1.57; CPC score, adjusted HR: 2.03; 95% CI: 1.77 to 2.34). ICD therapy was associated with better survival even after adjusting for neurological status (HR: 0.56; 95% CI: 0.43 to 0.73). A significant proportion of patients in the worse CPC categories had a >1-year survival after the index SCA.
Conclusions In SCA survivors, worse neurological performance was associated with lower likelihood of ICD insertion and higher mortality. ICD insertion was associated with improved survival even after accounting for neurological performance. ICD discussion should therefore not be omitted in these patients.
Dr. Wang has served as a consultant for Abbott; served as a research investigator for Boston Scientific; and received fellowship support from Abbott and Medtronic. Dr. Jain has received research grant support from Medtronic and Boston Scientific. Dr. Estes has served as a consultant for Medtronic, St. Jude Medical, and Boston Scientific. Dr. Saba has received research support from Boston Scientific and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received December 13, 2018.
- Revision received March 26, 2019.
- Accepted April 18, 2019.
- 2019 American College of Cardiology Foundation
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