Jung-Min Ahn1, Ki Hong Lee2, Sang-Yong Yoo3, Young-Rak Cho4, Jon Suh5, Eun-Seok Shin6, Jae-Hwan Lee7, Dong Il Shin8, Sung-Hwan Kim9, Sang Hong Baek10, Ki Bae Seung9, Chang-Wook Nam10, Eun-Sun Jin11, Se-Whan Lee12, Jun-Hyok Oh13, Jae Hyun Jang1, Hyung Wook Park2, Nam Sik Yoon2, Jeong Gwan Cho2, Cheol Hyun Lee1, Duk-Woo Park1, Soo-Jin Kang1, Seung-Whan Lee13, Jun Kim1, Young-Hak Kim1, Ki-Byung Nam1, Cheol Whan Lee1, Kee-Joon Choi14, Jae-Kwan Song1, You-Ho Kim1, Seong-Wook Park1, Seung-Jung Park15. 1. Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. 2. Chonnam National University Hospital, Gwangju, South Korea. 3. Department of Cardiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea. 4. Department of Cardiology, Dong-A University Hospital, Busan, South Korea. 5. Department of Cardiology, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea. 6. Ulsan University Hospital, Ulsan, South Korea. 7. Department of Cardiology, Chungnam National University Hospital, Daejeon, South Korea. 8. Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea. 9. Department of Cardiovascular Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea. 10. Keimyung University Dongsan Medical Center, Daegu, South Korea. 11. Kyung Hee University Hospital, Gangdong, Seoul, South Korea. 12. Department of Cardiology, Soonchunhyang University Hospital Cheonan, Cheonan, South Korea. 13. Pusan National University Hospital, Busan, South Korea. 14. Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: kjchoi@amc.seoul.kr. 15. Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: sjpark@amc.seoul.kr.
Abstract
BACKGROUND: 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.
BACKGROUND: 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.
Authors: W Vlastra; M Piek; M A van Lavieren; M E J C Hassell; B E Claessen; G W Wijntjens; T P van de Hoef; K D Sjauw; M A Beijk; R Delewi; J J Piek Journal: Neth Heart J Date: 2018-01 Impact factor: 2.380
Authors: Patrick J Coppler; Benjamin S Abella; Clifton W Callaway; Minjung Kathy Chae; Seung Pill Choi; Jonathan Elmer; Won Young Kim; Young-Min Kim; Michael Kurz; Joo Suk Oh; Joshua C Reynolds; Jon C Rittenberger; Kelly N Sawyer; Chun Song Youn; Byung Kook Lee; David F Gaieski Journal: Clin Exp Emerg Med Date: 2018-04-30
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