Abstract 13508: Patients with Vasospastic Angina Survived from Out-of-Hospital Cardiac Arrest as a High-Risk Population for Major Adverse Cardiac Events -A Report from the Nationwide Multi-Center Registry by the Japanese Coronary Spasm Association-
Background: Coronary vasospasm plays an important role in the pathogenesis of a wide variety of ischemic heart diseases; however, its role in sudden out-of-hospital cardiac arrest (OHCA) remains to be fully elucidated. Clinical features and outcomes of OHCA survivors were studied in the nationwide multi-center registry study of vasospastic angina (VSA) by the Japanese Coronary Spasm Association.
Methods: Between September 2007 and December 2008, a total of 1,521 VSA patients (M/F, 1163/358; 65±11 [SD] years), including 38 patients (2.5%) survived from OHCA, were registered from 47 institutes with a mean follow-up period of 36 months. VSA was diagnosed on the basis of the Japanese Circulation Society Guideline 2008.
Results: The OHCA survivors, as compared with the 1,483 non-OHCA patients, were characterized by younger age (55±15 vs. 65±10 years, p<0.001), higher incidence of the spasm in the left anterior descending coronary artery (74 vs. 53%, p=0.013) and of multi-vessel spasm (46 vs. 30%, p=0.043). In the OHCA survivors, 16 patients underwent implantable cardioverter defibrillator (ICD) implantation while intensively treated with calcium channel blockers. Five-year survival rate free from major adverse cardiac events (MACE) was significantly lower in the OHCA survivors compared with the non-OHCA patients (76 vs. 92%, p=0.002), including appropriate ICD shocks for ventricular fibrillation in 2 patient (Figure). Cox model multivariate analysis following adjustment for potential confounders such as age, gender, smoking, multi-vessel spasm and organic coronary stenosis demonstrated that OHCA event was a significant predictor of MACE (hazard ratio, 2.71; 95% confidence interval, 1.14 to 6.43; p=0.024).
Conclusions: These results of the largest VSA cohort indicate that patients survived from OHCA are particularly high risk population. Further studies are needed to determine whether ICD therapy improves the prognosis of those patients.
- Coronary vasospasm
- Cardiac arrest
- Ischemic heart disease
- Implantable cardioconvert defibrillator
- © 2010 by American Heart Association, Inc.