[Spontaneous coronary spasm as a rare cause of survived sudden cardiac death]

A 39-year-old man was admitted to our intensive care unit after successful resuscitation because of ventricular fibrillation with clinical and electrographic signs of acute myocardial infarction. Coronary angiography showed normal coronary arteries. MINC syndrome (myocardial infarction with angiographically normal coronary arteries) was due to a severe proximal spontaneous spasm of the left anterior descending artery (LAD). Intracoronary ultrasound imaging demonstrated an eccentric fibrous plaque in the proximal segment of LAD and a fibrofatty plaque distal to the spastic segment. At the time of electrophysiologic study, the patient was noninducible. After starting therapy with calcium antagonist, nitrate and molsidomine, the patient was stable and symptom-free.

Coronary spasm without significant organic stenosis is an important cause of sudden cardiac arrest and MINC syndrome. Because of the good prognosis under adequate treatment, exact diagnosis is important in the prevention of sudden death.