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Clinical characteristics associated with sudden death in patients with variant angina
Insights
Variant angina patients experiencing serious arrhythmias during ST-elevation episodes face a significantly higher risk of sudden cardiac death. These arrhythmias, not coronary disease extent or left ventricular dysfunction, are key predictors of mortality.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Variant angina, characterized by transient coronary artery spasm, poses a risk for sudden cardiac events.
- Understanding predictors of sudden cardiac death (SCD) in these patients is crucial for risk stratification.
Purpose of the Study:
- To investigate the relationship between serious arrhythmias during ST-elevation episodes and the risk of sudden cardiac death in variant angina patients.
- To identify clinical and electrocardiographic factors associated with SCD in this population.
Main Methods:
- A prospective follow-up study of 114 variant angina patients post-hospital discharge for a mean of 26 months.
- Continuous electrocardiographic monitoring during spontaneous ST-elevation episodes to detect arrhythmias.
- Comparison of clinical variables, coronary disease extent, left ventricular function, and ST-segment elevation between patients with and without serious arrhythmias and those experiencing SCD.
Main Results:
- Serious arrhythmias (ventricular fibrillation, ventricular tachycardia, high-degree AV block, asystole) occurred in 56% of patients during ST-elevation episodes.
- Patients with serious arrhythmias showed significantly higher maximal ST elevation (7.5 mm vs 3.3 mm) compared to those without.
- SCD or resuscitation from SCD occurred in 19 patients; 16 of these had serious arrhythmias during ST-elevation episodes (p < 0.01).
- Sudden death occurred in 42% of patients with serious arrhythmias versus 6% without (p < 0.001).
Conclusions:
- Serious arrhythmias during spontaneous ST-elevation episodes are a strong predictor of sudden cardiac death in variant angina patients.
- The degree of ischemia, indicated by maximal ST elevation, is higher in patients with serious arrhythmias.
- Risk stratification for sudden cardiac death in variant angina should consider the presence of severe arrhythmias during ischemic episodes.
Abstract:
After hospital discharge, 114 patients with variant angina were followed for a mean period of 26 months. Six died suddenly and 13 others were resuscitated from sudden cardiac death. The extent of coronary disease and the prevalence of left ventricular dysfunction in these 19 "sudden death" patients were similar to those in the patients who did not experience sudden death ("survivors"). During spontaneous episodes of ST elevation recorded in hospital, 56 of the 114 patients had serious arrhythmias: ventricular fibrillation in two, ventricular tachycardia in 28, ventricular couplets or bigeminy in 17, second- or third-degree atrioventricular block in six and asystole in three. Patients with and those without these arrhythmias during attacks were similar with respect to extent of coronary disease, left ventricular function and most other clinical variables. The maximal ST elevation, however, was higher in the arrhythmia group (7.5 +/- 5.7 vs 3.3 +/- 2.3 mm, p less than 0.01). Serious arrhythmias were detected in 16 of the 19 sudden death patients, compared with 36 of the 86 survivors (p less than 0.01). Sudden death occurred during follow-up in 15 of the 36 patients (42%) with ventricular fibrillation, ventricular tachycardia, high-degree atrioventricular block or asystole during attacks, compared with only four of 69 (6%) without these arrhythmias (p less than 0.001). We conclude that variant angina patients with serious arrhythmias during spontaneous attacks differ from other variant angina patient only in the degree of ischemia during attacks, as reflected by maximal ST elevation, but are at a much higher risk for sudden death.