Résumé
Introduction: Despite improvement of in-hospital survival rate after aborted sudden cardiac death (SCD), cerebral anoxia may have severe neurologic consequences and may impair long term outcome and quality of life of surviving patients.
Methods: This prospective, observational and multicentre (Montpellier and Nimes) study included patients > 18 yo admitted in the cathlab for CA after aborted SCD between May 1, 2018 to May 31, 2020. Only patients who were discharged alive from hospital were evaluated. The primary end point was survival without neurological sequelae at one year follow-up defined by Cerebral Performance Category (CPC) of 1 or 2. Secondary end points included global mortality, NYHA functional class, neurologic evaluation at discharge, 3-months and 1 year follow-up using the CPC scale, and quality of life at 1 year using the QOLIBRI (Quality of LIfe after BRain Injury) questionnaire.
Results: Among 143 patients included during the study period, 61 (43%) were discharged alive from hospital and 55 (90%) of them completed follow-up at 1 year. Patients were young (59.4 +/- 14.1), mainly male (77%), with few cardiovascular risk factors. Duration of no and low flow period was short (1.9 +/- 2.4 and 16.5 +/- 10.4 minutes respectively). For 93% of the surviving patients, an initial shockable rhythm (n=57) was observed and acute coronary syndrome (ACS) was diagnosed in 75% of them (n=46). At 1 year, survival rate without neurologic sequelae was 87% (n=48). There were few recurrences of rhythm disorder (5%) or ischemic event (4%). Patients with poor outcome were older (p=0.036), have lower body mass index (p=0.013) and a lower initial LVEF (p=0.046). During follow-up, neurological status improved in 37% of patients presenting sequelae at discharge and overall quality of life was globally satisfying for 66% of patients according to the QOLIBRI questionnaire. No death from cardiac cause was reported, and mean LVEF at 1 year was improved (51.5 ± 9.2 vs 47.5 ± 11.5, p < 0.01).
Conclusion: Among patients admitted to the cathlab for aborted SCD, mainly related to ACS, less than half of them were alive at discharge. However, their 1-year survival rate without neurological sequelae was high and their overall quality of life was good.