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Ann Thorac Surg 1999;67:404-410
© 1999 The Society of Thoracic Surgeons

Original Articles

Identifying patients at low risk of death from cardiac failure after operation for postinfarct ventricular tachycardia

John P. Bourke, MDa, Janine Gray, PhDb, Colin J. Hilton, FRCSa, Stephen S. Furniss, MBa, Shahi Khan, FRCSa, Janet M. McComb, MDa, Ronald W.F. Campbell, FRCPa

a Cardiothoracic Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom
b Department of Medical Statistics, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom

Accepted for publication June 27, 1998.

Address reprint requests to Dr Bourke, University Department of Cardiology, Freeman Hospital, Freeman Rd, Newcastle upon Tyne, NE7 7DN, United Kingdom

Background. In unselected patients, cardiac failure accounted for most deaths after antiarrhythmic operation (ER) for postinfarction ventricular tachycardia (VT). This study aimed to determine whether patients at low risk of this outcome could be predicted from a retrospective analysis of variables from 100 consecutive ER patients.

Methods. Thirteen variables suggested by other researchers as predictive of outcome were analyzed. At the time of study, ER was the only therapy available for drug refractory VT.

Results. Only emergency ER, wall motion score less than 3 and Killip classification were significantly related to death from cardiac failure. The lack of correlation between emergency ER and variables of ER timing, VT less than 24 hours of ER or VT type implies that the need for emergency ER is also related to ventricular dysfunction. Multivariate analysis identified a group at particularly low risk of death with a specificity of 95%.

Conclusions. Patients at low risk of death after ER can be identified prospectively. In the implantable cardioverter defibrillator era, elective ER is best reserved for such patients. Emergency ER may still be justified in younger patients without comorbidity who will die of VT without it.






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Copyright © 1999 by The Society of Thoracic Surgeons.