Variant Angina and Aborted Sudden Cardiac Death

Area of Science:

• Cardiology
• Vascular Medicine
• Electrophysiology

Background:

• Variant angina, characterized by coronary artery spasm, typically has a good prognosis.
• However, vasospasm can precipitate life-threatening arrhythmias and cardiac arrest, even in previously healthy individuals.

Purpose of the Study:

• To review the epidemiology, pathogenesis, clinical spectrum, and management of variant angina.
• To examine outcomes in patients presenting with aborted sudden cardiac death (ASCD) due to variant angina.

Main Methods:

• Review of recent observational studies and current guidelines.
• Analysis of predictors for ASCD in variant angina patients.
• Evaluation of current treatment strategies, including medical therapy and implantable cardiac defibrillators (ICDs).

Main Results:

• Patients with variant angina and ASCD have a poorer prognosis than those without ASCD.
• Predictors of ASCD include age, hypertension, hyperlipidemia, family history of sudden cardiac death, and specific coronary artery spasm patterns.
• Medical therapy alone may be insufficient; ICD therapy is recommended for survivors of cardiac arrest and strongly considered for high-risk patients.

Conclusions:

• Variant angina patients with ASCD represent a high-risk group requiring careful management.
• While medical therapy is essential, ICD implantation is justified in selected cases.
• Further research is needed to establish the role of ICDs in improving survival for this population.