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J Am Coll Cardiol. 2016 Jul 12;68(2):137-45. doi: 10.1016/j.jacc.2016.04.050.

Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death.

Author information

1
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
2
Chonnam National University Hospital, Gwangju, South Korea.
3
Department of Cardiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea.
4
Department of Cardiology, Dong-A University Hospital, Busan, South Korea.
5
Department of Cardiology, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea.
6
Ulsan University Hospital, Ulsan, South Korea.
7
Department of Cardiology, Chungnam National University Hospital, Daejeon, South Korea.
8
Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea.
9
Department of Cardiovascular Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
10
Keimyung University Dongsan Medical Center, Daegu, South Korea.
11
Kyung Hee University Hospital, Gangdong, Seoul, South Korea.
12
Department of Cardiology, Soonchunhyang University Hospital Cheonan, Cheonan, South Korea.
13
Pusan National University Hospital, Busan, South Korea.
14
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: kjchoi@amc.seoul.kr.
15
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: sjpark@amc.seoul.kr.

Abstract

BACKGROUND:

The long-term prognosis of patients with variant angina presenting with aborted sudden cardiac death (ASCD) is unknown.

OBJECTIVES:

The purpose of this study was to evaluate the long-term mortality and ventricular tachyarrhythmic events of variant angina with and without ASCD.

METHODS:

Between March 1996 and September 2014, 188 patients with variant angina with ASCD and 1,844 patients with variant angina without ASCD were retrospectively enrolled from 13 heart centers in South Korea. The primary endpoint was cardiac death.

RESULTS:

Predictors of ASCD manifestation included age (odd ratio [OR]: 0.980 by 1 year increase; 95% confidence interval [CI]: 0.96 to 1.00; p = 0.013), hypertension (OR: 0.51; 95% CI: 0.37 to 0.70; p < 0.001), hyperlipidemia (OR: 0.38; 95% CI: 0.25 to 0.58; p < 0.001), family history of sudden cardiac death (OR: 3.67; 95% CI: 1.27 to 10.6; p = 0.016), multivessel spasm (OR: 2.06; 95% CI: 1.33 to 3.19; p = 0.001), and left anterior descending artery spasm (OR: 1.40; 95% CI: 1.02 to 1.92; p = 0.04). Over a median follow-up of 7.5 years, the incidence of cardiac death was significantly higher in ASCD patients (24.1 per 1,000 patient-years vs. 2.7 per 1,000 patient-years; adjusted hazard ratio [HR]: 7.26; 95% CI: 4.21 to 12.5; p < 0.001). Death from any cause also occurred more frequently in ASCD patients (27.5 per 1,000 patient-years vs. 9.6 per 1,000 patient-years; adjusted HR: 3.00; 95% CI: 1.92 to 4.67; p < 0.001). The incidence rate of recurrent ventricular tachyarrhythmia in ASCD patients was 32.4 per 1,000 patient-years, and the composite of cardiac death and ventricular tachyarrhythmia was 44.9 per 1,000 patient-years. A total of 24 ASCD patients received implantable cardioverter-defibrillators (ICDs). There was a nonsignificant trend of a lower rate of cardiac death in patients with ICDs than those without ICDs (p = 0.15).

CONCLUSIONS:

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.

KEYWORDS:

angina; cardiac arrest; coronary spasm; vasospastic angina; ventricular tachyarrhythmic

PMID:
27386766
DOI:
10.1016/j.jacc.2016.04.050
[Indexed for MEDLINE]
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