Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death

Ahn, Jung‐Min; Lee, Ki Hong; Yoo, Sang-Yong; Cho, Young‐Rak; Suh, Jon; Shin, Eun‐Seok; Lee, Jae‐Hwan; Shin, Dong Il; Kim, Sunghwan; Baek, Sang Hong; Seung, Ki Bae; Nam, Chang‐Wook; Jin, Eun‐Sun; Lee, Se-Whan; Oh, Jun-Hyok; Jang, Jae Hyun; Park, Hyung Wook; Yoon, Nam Sik; Cho, Jeong Gwan; Lee, Cheol Hyun; Park, Duk‐Woo; Kang, Soo–Jin; Lee, Seung-Whan; Kim, Jun; Kim, Young‐Hak; Nam, Ki-Byung; Lee, Cheol Whan; Choi, Kee‐Joon; Song, Jae‐Kwan; Kim, You‐Ho; Park, Seong-Wook

doi:10.1016/j.jacc.2016.04.050

Cited by 106 publications

(91 citation statements)

References 29 publications

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“…Takagi et al showed that the incidence of cardiac death was significantly increased in patients for whom medications were reduced or discontinued 8. As shown in Figure 7A, the incidence of VF recurrence in the CAS group is consistent with that reported in previous studies 8, 21. In the current study (Figure 7B), 3 symptomatic patients with CAS experienced VF recurrence, with 2 of those experiencing VF recurrence after discontinuation of antianginal therapy.…”

Section: Discussionsupporting

confidence: 90%

“…13 However, patients with CAS with aborted sudden cardiac arrest have been linked to a poor prognosis compared with those without such a condition. 8,21 Ahn et al demonstrated that patients with CAS with a history of aborted sudden cardiac death remain at high risk despite antianginal therapy. 21 They reported that the annual incidence rate of recurrent ventricular tachyarrhythmia was %3%.…”

Section: Vf Recurrence and Treatment Of Ers And Casmentioning

confidence: 99%

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Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Kamakura

Wada

Ishibashi

et al. 2018

JAHA

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BackgroundPreviously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave).Methods and ResultsThe study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow‐up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF.ConclusionsApproximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.

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Section: Discussionsupporting

confidence: 90%

Section: Vf Recurrence and Treatment Of Ers And Casmentioning

confidence: 99%

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Kamakura

Wada

Ishibashi

et al. 2018

JAHA

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“…Consistent with this finding, a previous study showed that systemic hypertension was a predictor of major coronary evens in VA patients in a multivariable analysis6. Another study also showed that more advanced age, hypertension and dyslipidemia were independent predictors of sudden cardiac death in VA patients16. However, a contradicting result indicated that traditional risk factors such as hypertension, diabetes mellitus and hypertension did not affect VA prognosis26.…”

Section: Discussionmentioning

confidence: 66%

“…The incidence of VA mortality has been reported by several studies67111213141516171819202122. However, those reports were limited in size and/or duration of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…However, sometimes, severe coronary spasm causes acute myocardial infarction (AMI) and fatal arrhythmia such as ventricular tachycardia, ventricular fibrillation and complete atrioventricular block, and subsequent cardiac arrest and death111415. Even though some studies have investigated the outcomes and prognostic factors of patients with VA67111213141516171819202122, they had several weak points; first, sample sizes were relatively small and/or follow-up durations were short in most of those studies, therefore they would potentially have generalization problem; second. some of studies were performed several decades prior67131415, and the current VA treatment strategy using newer VA treatments such as K ATP channel agonist (nicorandil)2324, was not available for use in those studies.…”

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confidence: 99%

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Incidence and factors associated with mortality in 2,476 patients with variant angina in Korea

Kim

et al. 2017

Sci Rep

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This study investigated the incidence and risk factors of mortality in 2,476 patients with variant angina (VA) using the National Health Insurance Service–National Sample Cohort between 2004 and 2011. The risk factors of all-cause and cardiac mortality were investigated using Cox proportional hazards model. Most patients (69.5%) were less than 65 years and 42.9% were women. During the median follow-up duration of 4.9 years, there were 178 (7.2%) and 95 (3.8%) cases of all-cause and cardiac mortality, respectively. Older age, hypertension, diabetes mellitus, poor medication adherence, low household income and tertiary teaching hospitals were independent predictors for all-cause mortality, while older age, hypertension, low household income and tertiary teaching hospitals were independent predictors for cardiac mortality. In conclusion, our findings suggest that traditional risk factor control and continued medication are important to improve VA outcomes, and that household income-level factors should be considered in the assessment of risk of VA patients.

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A Young Woman With Refractory Vasospastic Angina

2019

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A woman in her early 30s with a history of mild bronchial asthma and nasal polyps presented to the emergency department with chest pain, electrocardiographic ST elevation, and sudden cardiac arrest. Cardiopulmonary resuscitation was initiated and was followed with coronary angiography, which showed significant 3-vessel stenosis that completely resolved after nitroglycerin injection. The patient was diagnosed as having vasospastic angina (VA); diltiazem and glyceryl trinitrate were prescribed, and an implantable cardioverter-defibrillator (ICD) was implanted.Two months later, she presented with similar symptoms to another hospital; her ICD had not delivered a shock. Because she was not carrying her medical records, she was immediately transferred to the catheterization laboratory. Angiography was again performed and showed severe spasm of all coronary vessels that resolved after nitroglycerin administration (Figure). Medical treatment was intensified by adding verapamil and a statin to the regimen.Four months later, the patient was admitted to our center in an unconscious state. The electrocardiogram showed asystole with pacemaker spikes not followed by QRS complexes. Cardiopulmonary resuscitation was started, but after 10 minutes of resuscitation there was no response. Given her history of VA, we started nitroglycerin infusion, which resulted in return to normal sinus rhythm after 5 minutes with a palpable peripheral pulse.Despite the intensification of therapy with isosorbide mononitrate and concomitant use of amlodipine, diltiazem, and benzodiazepine, the patient experienced another episode of asystole and multiple episodes of asymptomatic ST-T changes in the coronary care unit. Her ejection fraction declined to 30%. Coronary arteries during cardiac A Coronary arteries after nitroglycerin administration B Figure. Total occlusion of all coronary arteries during cardiac arrest (A) that was completely resolved after nitroglycerin administration (B).

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Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death

Abstract: The prognosis of patients with variant angina with ASCD was worse than other patients with variant angina. In addition, our findings supported ICDs in these high-risk patients as a secondary prevention because current multiple vasodilator therapy appeared to be less optimal.

Cited by 106 publications

References 29 publications

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Incidence and factors associated with mortality in 2,476 patients with variant angina in Korea

A Young Woman With Refractory Vasospastic Angina

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