Among patients with vasospastic angina, surviving an out-of-hospital cardiac arrest was associated with a significantly higher risk of major adverse cardiac events (HR 3.25; 95% CI 1.39-7.61; P<0.01).
Cohort (n=1,429)
Yes
Does a history of out-of-hospital cardiac arrest increase the risk of major adverse cardiac events in patients with vasospastic angina?
Vasospastic angina patients who survive an out-of-hospital cardiac arrest represent a high-risk population with a significantly increased rate of subsequent major adverse cardiac events.
Hazard Ratio: 3.25 (95% CI 1.39–7.61)
Absolute Event Rate: 72% vs 92%
p-value: p=<0.01
BACKGROUND: Coronary artery spasm plays an important role in the pathogenesis of ischemic heart disease; however, its role in sudden cardiac death remains to be fully elucidated. We examined the clinical characteristics and outcomes of patients with vasospastic angina (VSA) in our nationwide multicenter registry by the Japanese Coronary Spasm Association. METHODS AND RESULTS: Between September 2007 and December 2008, 1429 patients with VSA (male/female, 1090/339; median, 66 years) were identified. They were characterized by a high prevalence of smoking and included 35 patients who survived out-of-hospital cardiac arrest (OHCA). The OHCA survivors, as compared with the remaining 1394 non-OHCA patients, were characterized by younger age (median, 58 versus 66 years; P<0.001) and higher incidence of left anterior descending coronary artery spasm (72% versus 53%, P<0.05). In the OHCA survivors, 14 patients underwent implantable cardioverter-defibrillator (ICD) implantation while intensively treated with calcium channel blockers. Survival rate free from major adverse cardiac events was significantly lower in the OHCA survivors compared with the non-OHCA patients (72% versus 92% at 5 years, P<0.001), including appropriate ICD shocks for ventricular fibrillation in 2 patients. Multivariable analysis revealed that OHCA events were significantly correlated with major adverse cardiac events (hazard ratio, 3.25; 95% confidence interval, 1.39 to 7.61; P<0.01). CONCLUSIONS: These results from the largest vasospastic angina cohort indicate that vasospasm patients who survived OHCA are high-risk population. Further studies are needed to determine whether implantable cardioverter-defibrillator therapy improves patient prognosis.
Takagi et al. (Wed,) conducted a cohort in Vasospastic angina (n=1,429). Out-of-hospital cardiac arrest (OHCA) vs. No out-of-hospital cardiac arrest was evaluated on Survival free from major adverse cardiac events (HR 3.25, 95% CI 1.39-7.61, p=<0.01). Among patients with vasospastic angina, surviving an out-of-hospital cardiac arrest was associated with a significantly higher risk of major adverse cardiac events (HR 3.25; 95% CI 1.39-7.61; P<0.01).