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Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death

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Author(s)
Jung-Min AhnKi Hong LeeSang-Yong YooYoung-Rak ChoJon SuhEun-Seok ShinJae-Hwan LeeDong Il ShinSung-Hwan KimSang Hong BaekKi Bae SeungChang-Wook NamEun-Sun JinSe-Whan LeeJun-Hyok OhJae Hyun JangHyung Wook ParkNam Sik YoonJeong Gwan ChoCheol Hyun LeeDuk-Woo ParkSoo-Jin KangSeung-Whan LeeJun KimYoung-Hak KimKi-Byung NamCheol Whan LeeKee-Joon ChoiJae-Kwan SongYou-Ho KimSeong-Wook Park and Seung-Jung Park
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
Journal of American College of Cardiology
Issued Date
2016
Volume
68
Issue
2
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.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine
Citation
Jung-Min Ahn et al. (2016). Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death. Journal of American College of Cardiology, 68(2), 137–145. doi: 10.1016/j.jacc.2016.04.050
Type
Article
ISSN
0735-1097
DOI
10.1016/j.jacc.2016.04.050
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/32484
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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