Postcardioplegia ventricular fibrillation: No impact on subsequent survival

Figures & data

Table I. Baseline variables.

Variable	No VF n = 9723 (Group 1)	VF converted with K^+ n = 1877 (Group 2)	VF not converted with K^+ n = 400 (Group 3)	P value
Age years	67.9 ± 10.1	65.9 ± 9.9	65.1 ± 10.5	< 0.001
Male %	72.7	82.7	91.0	< 0.001
Elective surgery %	75.6	75.3	69.0	0.013
CABG %	90.4	94.0	91.3	< 0.001
AVR %	17.7	10.5	15.0	< 0.001
Mitral valve operation %	1.7	0.6	1.3	< 0.001
CABG plus AVR or mitral surgery %	10.5	5.1	7.8	< 0.001
Redo surgery %	3.3	3.6	7.0	< 0.001
CPB minutes	52.2 ± 22.9	47.8 ± 21.5	55.7 ± 27.5	< 0.001
Arrest time minutes	33.7 ± 17.5	29.5 ± 15.8	33.9 ± 20.8	< 0.001
Diabetes %	17.2	16.3	16.3	0.608
Pulmonary disease %	13.3	13.9	15.5	0.368
Hypercholesterolemia %	78.3	80.5	76.5	0.066
Hypertension %	52.8	55.3	55.8	0.079
Unstable angina %	26.4	27.1	31.0	0.119
Previous infarction %	45.7	44.0	53.8	0.002
Previous PCI %	16.3	15.8	16.3	0.879
No coronary disease %	8.4	6.0	6.8
One vessel disease %	5.0	4.0	3.8
Two vessel disease %	17.2	18.1	21.4
Three vessel disease %	69.4	72.0	68.1	< 0.001
Ejection fraction	64.7 ± 13.3	65.3 ± 13.0	60.0 ± 15.0	< 0.001
BMI	26.6 ± 3.9	27.6 ± 4.2	28.0 ± 4.2	< 0.001
Euroscore	4.7 ± 3.2	4.0 ± 2.9	4.5 ± 3.2	< 0.001
Logistic euroscore	5.9 ± 7.7	4.7 ± 6.3	6.0 ± 7.9	< 0.001
ASA classification > 3 %	34.1	28.2	36.8	< 0.001
Betablocker %	76.4	77.9	80.0	0.110
Calcium antagonist %	20.3	24.5	24.5	< 0.001
ACE inhibitor %	36.0	36.0	32.3	0.309
Diuretics %	19.3	16.0	24.8	< 0.001
Statin %	71.9	73.0	68.5	0.176
Aspirin %	83.2	84.3	82.0	0.373
Clopidogrel %	21.1	19.4	18.2	0.126
Warfarin %	7.0	6.8	5.5	0.545
Hemoglobin g/dl	14.0 ± 1.4	14.3 ± 1.3	14.3 ± 1.5	< 0.001
Creatinine μmol/l	93.2 ± 23.2	92.0 ± 19.0	93.7 ± 19.7	0.309
ASAT U/l	28.5 ± 17.8	28.5 ± 19.7	28.8 ± 16.9	0.881
ALAT U/l	33.7 ± 25.5	35.7 ± 27.9	36.6 ± 30.7	< 0.001

Data presented as mean ± standard deviation or %; ACE, angiotensin-converting enzyme; ALAT, alanine aminotransferase; ASA, American Society of Anesthesiology; ASAT, aspartate aminotransferase; AVR; aortic valve replacement; BMI, body mass index; CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; PCI, percutaneous coronary intervention; VF, ventricular fibrillation.

Table II. Postoperative data.

Variable	No VF n = 9723 (Group 1)	VF converted with K^+ n = 1877 (Group 2)	VF not converted with K^+ n = 400 (Group 3)	P value
30-day mortality %	1.2	0.8	1.3	0.269
Myocardial infarction %	0.9	0.8	0.5	0.699
Stroke %	1.0	1.1	1.5	0.500
Ventilator > 24 h %	0.9	0.7	0.5	0.737
Reopening for bleeding %	2.0	1.8	3.5	0.101
Reopening for mediastinitis %	0.5	0.6	0.8	0.600
Atrial fibrillation %	36.7	36.9	39.3	0.586
Inotropic drugs %	3.6	2.6	6.8	< 0.001
IABP %	0.4	0.3	0.3	0.802
Blood transfusion %	35.3	24.3	28.8	< 0.001
ASAT maximum U/L	72.9 ± 280.7	76.6 ± 483.9	64.7 ± 64.1	0.159
ALAT maximium U/L	53.1 ± 146.2	59.4 ± 337.2	49.7 ± 66.4	0.003
Creatinine maximum μmol/l	98.9 ± 37.7	96.2 ± 29.6	98.8 ± 30.7	0.164
Hemoglobin at discharge g/dl	10.8 ± 2.0	11.0 ± 2.3	11.0 ± 1.2	< 0.001

Data presented as mean ± standard deviation or %; ALAT, alanine aminotransferase; ASAT, aspartate aminotransferase; IABP, intra-aortic balloon pump; VF, ventricular fibrillation.

Figure 1. Kaplan–Meier failure estimates showing reduced unadjusted survival for the failed potassium treatment group (p = 0.0006, log-rank test).

Figure 2. Cox proportional hazard regression analysis showing identical survival curves for patients without ventricular fibrillation and patients with successful potassium treatment. Patients with failed potassium treatment show a trend toward an increased mortality (HR, 1.19, 95% CI, 0.99–1.4; P = 0.070).