Background-Remnant lipoproteins are atherogenic, but assays of remnants have not been available in routine clinical laboratories because of the lack of practical and validated methods. A simple and reliable method for such an assay, using an immunochemical approach, has recently been developed. This study prospectively examined whether remnant lipoprotein levels in fasting serum, measured by our method, may have prognostic value in patients with coronary artery disease (CAD). Methods and Results-Remnant lipoprotein levels in fasting serum were measured in 135 patients with CAD by an immunoaffinity mixed gel containing anti-apolipoprotein (apo) A-1 and anti-apoB-100 monoclonal antibodies. Patients were followed up for Յ36 months until occurrence of 1 of the following clinical coronary events: recurrent or refractory angina pectoris requiring coronary revascularization, nonfatal myocardial infarction, or cardiac death. Kaplan-Meier analysis demonstrated a significantly higher probability of developing coronary events in patients with the highest tertile of remnant levels (Ͼ5.1 mg cholesterol/dL; 75th percentile of distribution of remnant levels) than in those with the lowest tertile of remnant levels (Յ3.3 mg cholesterol/dL; 50th percentile of the distribution). Higher levels of remnants were a significant and independent predictor of developing coronary events in multivariate Cox hazard analysis including the following covariates: extent of coronary artery stenosis, age, sex, smoking, hypertension, diabetes mellitus, hypercholesterolemia, low HDL cholesterol, and hypertriglyceridemia. Conclusions-Higher levels of remnant lipoproteins in fasting serum predict future coronary events in patients with CAD independently of other risk factors. Thus, measurement of fasting remnant levels, assessed by the current immunoseparation method, may be helpful in assessment of CAD risk. (Circulation. 1999;99:2858-2860.)

on behalf of the Japanese Coronary Spasm Association 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. 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; PϽ0.001) and higher incidence of left anterior descending coronary artery spasm (72% versus 53%, PϽ0.05). 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, PϽ0.001), 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; PϽ0.01). 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. (Circ Arrhythm Electrophysiol. 2011;4:295-302.) Methods and Results-BetweenKey Words: acetylcholine Ⅲ angina pectoris Ⅲ arrhythmia, cardiac Ⅲ prognosis Ⅲ coronary vasospasm O ut-of-hospital cardiac arrest (OHCA) is a major public health problem. Its estimated number is 300 000 to 400 000 per year in the United States. 1 A prospective study showed an incidence of 53 in 100 000 per year, with 25% of victims being younger than 65 years. 2 Causes of OHCA are strongly associated with coronary artery disease as evidenced at autopsy, and the survival rate from OHCA still remains to be substantially improved. 1 Importantly, a significant number of OHCA cases remained unexplained if victims have no structural abnormalities (eg, organic coronary stenosis) in the postmortem analysis. 3 This finding strongly suggests that functional abnormalities of the coronary artery are also involved in the pathogenesis of OHCA. 4 Clinical Perspective on p 302Recently, the prevalence of early access to emergency medical service, early bystander cardiopulmonary resuscitation, and early defibrillation has been increasing, with a resultant improvement of the survival rate from OHCA. [5][6][7] The progress of the chain of survival now opens the window to elucidate the underlying mechanisms of patients who surviv...

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