Questionnaire in patients with aborted sudden cardiac death due to coronary spasm in Japan
Shozo Sueda1, Tetsuji Shinohara2, Naohiko Takahashi2
1Department of Cardiology, Ehime Prefectural Niihama Hospital, Hongou 3 choume 1-1, Niihama City, Ehime Prefecture, 792-0042, Japan. EZF03146@nifty.com.
Insights
Japanese cardiologists lack a unified strategy for aborted sudden cardiac death (ASCD) due to coronary spasm. Current practices vary, highlighting a need for standardized knowledge and treatment approaches for these critical cardiac events.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Pharmacology
Background:
- Coronary spasm is a significant cause of aborted sudden cardiac death (ASCD).
- Current knowledge and therapeutic strategies among Japanese cardiologists for ASCD due to coronary spasm are not well-defined.
Purpose of the Study:
- To investigate the current medical and mechanical therapeutic approaches for ASCD caused by coronary spasm.
- To assess the existing knowledge base of Japanese cardiologists regarding ASCD management due to coronary spasm.
Main Methods:
- A questionnaire survey was distributed to 204 Japanese cardiology institutions.
- The survey collected data on ASCD cases, implantable cardioverter-defibrillator (ICD) use, and medical therapies for ASCD patients with coronary spasm.
Main Results:
- A 16.7% response rate yielded data from 34 hospitals, identifying 169 cases of ASCD due to coronary spasm.
- Two-thirds of patients received one or two coronary vasodilators, while ICDs were implanted in 117 patients; a lower number of vasodilators was associated with ICD use (p < 0.001).
- Spasm provocation tests under medication were infrequently performed, despite perceived clinical usefulness by some institutions.
Conclusions:
- There is a lack of a standardized, fundamental strategy for managing ASCD due to coronary spasm in Japan.
- Individual institutions employ diverse approaches, indicating a need for unified strategies and shared knowledge among cardiologists.
- Future efforts should focus on developing consistent management protocols for ASCD patients experiencing coronary spasm.
Objectives:
We investigated the medical or mechanical therapy, and the present knowledge of Japanese cardiologists about aborted sudden cardiac death (ASCD) due to coronary spasm.
Methods:
A questionnaire was developed regarding the number of cases of ASCD, implantable cardioverter-defibrillator (ICD), and medical therapy in ASCD patients due to coronary spasm. The questionnaire was sent to the Japanese general institutions at random in 204 cardiology hospitals.
Results:
The completed surveys were returned from 34 hospitals, giving a response rate of 16.7%. All SCD during the 5 years was observed in 5726 patients. SCD possibly due to coronary spasm was found in 808 patients (14.0%) and ASCD due to coronary spasm was observed in 169 patients (20.9%). In 169 patients with ASCD due to coronary spasm, one or two coronary vasodilators was administered in two-thirds of patients [113 patients (66.9%)], while more than 3 coronary vasodilators were found in 56 patients (33.1%). ICD was implanted in 117 patients with ASCD due to coronary spasm among these periods including 35 cases with subcutaneous ICD. Majority of cause of ASCD was ventricular fibrillation, whereas pulseless electrical activity was observed in 18 patients and complete atrioventricular block was recognized in 7 patients. Mean coronary vasodilator number in ASCD patients with ICD was significantly lower than that in those without ICD (2.1 ± 0.9 vs. 2.6 ± 1.0, p < 0.001). Although 16 institutions thought that the spasm provocation tests under the medications had some clinical usefulness of suppressing the next fatal arrhythmias, spasm provocation tests under the medication were performed in just 4 institutions.
Conclusions:
In the real world, there was no fundamental strategy for patients with ASCD due to coronary spasm. Each institution has each strategy for these patients. Cardiologists should have the same strategy and the same knowledge about ASCD patients due to coronary spasm in the future.
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