Out-of-hospital cardiac arrest related to coronary arterial spasm in three elderly patients with no obstructive coronary artery disease

Abstract

Patients with coronary spastic angina (CSA) are often younger and exhibit fewer classic cardiovascular risk factors except for smoking [1]. In general, patients with CSA who respond to calcium channel blockers have a good prognosis; consequently, the 5-yearsurvival rate of CSA is more than 90% [2,3]. In a Japanese registry study including 1429 patients with CSA [4], 5.9% reached the primary major adverse cardiovascular event (MACE) combined endpoint [cardiac death, nonfatal myocardial infarction, unstable angina, heart failure, or implantable cardioverter defibrillator (ICD) shock] during a median follow-up of 32 months [4]. Patients with CSA who have obstructive coronary artery disease have a poorer prognosis [4,5]. Here, we present three cases of out-of-hospital cardiac arrest (OHCA) likely due to coronary spasm in the presence of nonobstructive coronary artery disease in men older than 65 years. We consider the prognosis of elderly CSA patients and the association of CSA with OHCA.

Recurrent cardiac arrest and complete atrioventricular block due to idiopathic coronary vasospasm: A case report

“…The long-term outcomes of ICD for secondary prevention of coronary spasm-induced cardiac arrest remain unclear [ 13 ]. Some studies have reported that the first three months after the index event are the most critical period for cardiovascular events [ 14 ].…”