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Clinical characteristics of sudden cardiac death in patients with vasospastic angina
S Koyanagi1, A Takeshita, M Nakamura
1Research Institute of Angiocardiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Insights
Sudden cardiac death is uncommon in Japanese patients with vasospastic angina. Multivessel coronary spasm and serious arrhythmia during anginal attacks increase sudden death risk.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Vasospastic angina (VSA) is a condition characterized by transient coronary artery spasms.
- Sudden cardiac death (SCD) is a significant concern in patients with cardiovascular diseases.
Purpose of the Study:
- To investigate the incidence and risk factors of SCD in Japanese patients with VSA.
- To evaluate the association between SCD and clinical characteristics, including coronary spasm patterns and arrhythmias.
Main Methods:
- A retrospective cohort study followed 383 Japanese patients with VSA for 3.2 years.
- Data collected included patient demographics, coronary angiography findings, electrocardiographic changes during angina, and clinical outcomes (SCD).
Main Results:
- The overall incidence of SCD was low (2%) in this cohort.
- Multivessel coronary spasm (12.5% SCD rate) significantly increased SCD risk compared to single-vessel spasm (1% SCD rate) (p<0.01).
- Serious arrhythmias during anginal episodes were more frequent in patients who died suddenly (53%) versus those who did not (14%).
Conclusions:
- Sudden cardiac death is infrequent in Japanese patients with vasospastic angina.
- Multivessel coronary spasm and the presence of serious arrhythmias during anginal attacks are significant risk factors for SCD in this population.
- Fixed coronary stenosis was not identified as a risk factor for SCD in this study.
Abstract:
Of 383 patients with vasospastic angina who were followed for a period of 3.2 +/- 0.1 years, 9 (2%) died suddenly from cardiac causes. Calcium antagonists had been given to 98% of our patients. Only one patient who died suddenly had a fixed coronary stenosis of 75% or greater. Eight of the 9 patients showed ST segment elevation during anginal attack at rest, and 3 patients showed ST segment elevation at both anterior and inferior leads. Sudden death occurred in 6 of 41 patients (12.5%) who were documented to have multivessel coronary spasm, but in only 3 of 342 patients (1%) who had single vessel spasm (p less than 0.01). Serious arrhythmia occurred during anginal episode in 3 of 9 patients who died suddenly (53%) and in 52 of 374 who did not (14%). These results suggest that the frequency of sudden cardiac death was rather low in Japanese patients with vasospastic angina. The risk of sudden death was increased in patients with multivessel spasm and serious arrhythmia during anginal attacks but not these with fixed coronary stenosis.