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Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death

Jung-Min Ahn1, Ki Hong Lee2, Sang-Yong Yoo3

  • 1Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.

Journal of the American College of Cardiology
|July 9, 2016
PubMed

Insights

Patients with variant angina and aborted sudden cardiac death (ASCD) face a significantly worse long-term prognosis. Early intervention with implantable cardioverter-defibrillators (ICDs) may improve outcomes in these high-risk individuals.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Clinical Research

Background:

  • The long-term prognosis for patients experiencing aborted sudden cardiac death (ASCD) alongside variant angina remains largely unknown.
  • Variant angina, also known as Prinzmetal's angina, is characterized by coronary artery spasms causing chest pain.

Purpose of the Study:

  • To evaluate and compare the long-term mortality rates and ventricular tachyarrhythmic events in patients with variant angina, stratified by the presence or absence of ASCD.
  • To identify predictors associated with ASCD manifestation in variant angina patients.

Main Methods:

  • A retrospective cohort study involving 188 patients with variant angina and ASCD and 1,844 patients with variant angina without ASCD, enrolled across 13 South Korean heart centers from March 1996 to September 2014.
  • Primary endpoint was cardiac death; secondary endpoints included all-cause mortality and recurrent ventricular tachyarrhythmia. Statistical analysis involved calculating odds ratios (OR), confidence intervals (CI), and hazard ratios (HR).

Main Results:

  • Predictors for ASCD included older age, hypertension, hyperlipidemia, family history of sudden cardiac death, multivessel spasm, and left anterior descending artery spasm.
  • Over a median follow-up of 7.5 years, ASCD patients exhibited significantly higher cardiac death rates (24.1 vs. 2.7 per 1,000 patient-years; adjusted HR: 7.26) and all-cause mortality (27.5 vs. 9.6 per 1,000 patient-years; adjusted HR: 3.00).
  • The incidence of recurrent ventricular tachyarrhythmia was 32.4 per 1,000 patient-years in ASCD patients. A non-significant trend towards lower cardiac death was observed in the 24 ASCD patients who received implantable cardioverter-defibrillators (ICDs).

Conclusions:

  • Patients with variant angina presenting with ASCD have a demonstrably worse long-term prognosis compared to those without ASCD.
  • The findings support the consideration of ICDs for secondary prevention in high-risk variant angina patients with ASCD, as current vasodilator therapies may be suboptimal.
Abstract

Keywords:
anginacardiac arrestcoronary spasmvasospastic anginaventricular tachyarrhythmic

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