Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death

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• 作者：Jung-Min Ahn ; MD^a ; Ki Hong Lee ; MD^b ; Sang-Yong Yoo ; MD^c ; Young-Rak Cho ; MD^d ; Jon Suh ; MD^e ; Eun-Seok Shin ; MD^f ; Jae-Hwan Lee ; MD^g ; Dong Il Shin ; MD^h ; Sung-Hwan Kim ; MDⁱ ; Sang Hong Baek ; MDⁱ ; Ki Bae Seung ; MDⁱ ; Chang-Wook Nam ; MD^j ; Eun-Sun Jin ; MD^k ; Se-Whan Lee ; MD^l ; Jun-Hyok Oh ; MD^m ; Jae Hyun Jang^a ; Hyung Wook Park ; MD^b ; Nam Sik Yoon ; MD^b ; Jeong Gwan Cho ; MD^b ; Cheol Hyun Lee ; MD^a ; Duk-Woo Park ; MD^a ; Soo-Jin Kang ; MD^a ; Seung-Whan Lee ; MD^m ; Jun Kim ; MD^a ; Young-Hak Kim ; MD^a ; Ki-Byung Nam ; MD^a ; Cheol Whan Lee ; MD^a ; Kee-Joon Choi ; MD^a ; ^{kjchoi@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author} ; Jae-Kwan Song ; MD^a ; You-Ho Kim ; MD^a ; Seong-Wook Park ; MD^a ; Seung-Jung Park ; MD^a ; ^{sjpark@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：angina ; cardiac arrest ; coronary spasm ; vasospastic angina ; ventricular tachyarrhythmic
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：12 July 2016
• 年：2016
• 卷：68
• 期：2
• 页码：137-145
• 全文大小：956 K

文摘

The long-term prognosis of patients with variant angina presenting with aborted sudden cardiac death (ASCD) is unknown.

Objectives

The purpose of this study was to evaluate the long-term mortality and ventricular tachyarrhythmic events of variant angina with and without ASCD.

Methods

Between March 1996 and September 2014, 188 patients with variant angina with ASCD and 1,844 patients with variant angina without ASCD were retrospectively enrolled from 13 heart centers in South Korea. The primary endpoint was cardiac death.

Results

Predictors of ASCD manifestation included age (odd ratio [OR]: 0.980 by 1 year increase; 95% confidence interval [CI]: 0.96 to 1.00; p = 0.013), hypertension (OR: 0.51; 95% CI: 0.37 to 0.70; p < 0.001), hyperlipidemia (OR: 0.38; 95% CI: 0.25 to 0.58; p < 0.001), family history of sudden cardiac death (OR: 3.67; 95% CI: 1.27 to 10.6; p = 0.016), multivessel spasm (OR: 2.06; 95% CI: 1.33 to 3.19; p = 0.001), and left anterior descending artery spasm (OR: 1.40; 95% CI: 1.02 to 1.92; p = 0.04). Over a median follow-up of 7.5 years, the incidence of cardiac death was significantly higher in ASCD patients (24.1 per 1,000 patient-years vs. 2.7 per 1,000 patient-years; adjusted hazard ratio [HR]: 7.26; 95% CI: 4.21 to 12.5; p < 0.001). Death from any cause also occurred more frequently in ASCD patients (27.5 per 1,000 patient-years vs. 9.6 per 1,000 patient-years; adjusted HR: 3.00; 95% CI: 1.92 to 4.67; p < 0.001). The incidence rate of recurrent ventricular tachyarrhythmia in ASCD patients was 32.4 per 1,000 patient-years, and the composite of cardiac death and ventricular tachyarrhythmia was 44.9 per 1,000 patient-years. A total of 24 ASCD patients received implantable cardioverter-defibrillators (ICDs). There was a nonsignificant trend of a lower rate of cardiac death in patients with ICDs than those without ICDs (p = 0.15).

Conclusions

The prognosis of patients with variant angina with ASCD was worse than other patients with variant angina. In addition, our findings supported ICDs in these high-risk patients as a secondary prevention because current multiple vasodilator therapy appeared to be less optimal.