Coronary artery spasm in cardiac arrest survivors

Coronary artery spasm can be life-threatening. Clinically significant complications include myocardial infarction, ventricular arrhythmias, and sudden cardiac arrest. Although challenging to diagnose, new international guidelines have been published to guide the diagnosis of coronary artery spasm when this is the suspected cause of cardiac arrest. The aim of this review is to consider existing knowledge for the diagnosis and management of coronary artery spasm in survivors of sudden cardiac arrest. Twenty-seven original research articles (written in English) involving a total of 1541 survivors of sudden cardiac arrest associated with coronary artery spasm form the basis of this review. Most cohorts included >75% male participants with a mean age range of 45-63 years. A positive family history or coronary risk factors of coronary artery disease are not commonly found, albeit many survivors are smokers (ranged 17-100% across cohorts). Provocative testing for coronary spasm was reported in 25 of the evaluated papers, but the indications for testing were inconsistently specified. A high recurrence rate (up to 45%) of life-threatening ventricular arrhythmias was reported, and implantable cardioverter-defibrillator placement varied markedly. In conclusion, diagnosing coronary artery spasm as a cause of sudden cardiac arrest is challenging. The pathophysiological understanding is limited. Knowledge gaps include the incidence and prevalence, as well as the usefulness of provocative testing in survivors. More data are needed regarding patient risk stratification, indications for implantable cardioverter-defibrillator insertion, and optimal pharmacological therapy.