Clinical Characteristics and Long-Term Prognosis of Vasospastic Angina Patients Who Survived Out-of-Hospital Cardiac Arrest

Takagi, Yusuke; Yasuda, Satoshi; Tsunoda, Ryusuke; Ogata, Yasuhiro; Seki, Atsushi; Sumiyoshi, Tetsuya; Matsui, Motoyuki; Goto, Toshikazu; Tanabe, Yuji; Sueda, Shozo; Sato, Toshiaki; Ogawa, Satoshi; Kubo, Norifumi; Momomura, Shin Ichi; Ogawa, Hisao; Shimokawa, Hiroaki

doi:10.1161/circep.110.959809

Cited by 173 publications

(164 citation statements)

References 41 publications

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“…Takagi et al showed that the incidence of cardiac death was significantly increased in patients for whom medications were reduced or discontinued 8. As shown in Figure 7A, the incidence of VF recurrence in the CAS group is consistent with that reported in previous studies 8, 21. In the current study (Figure 7B), 3 symptomatic patients with CAS experienced VF recurrence, with 2 of those experiencing VF recurrence after discontinuation of antianginal therapy.…”

Section: Discussionsupporting

confidence: 90%

“…They reported that the annual incidence rate of recurrent ventricular tachyarrhythmia was ≈3% 21. Takagi et al showed that the incidence of cardiac death was significantly increased in patients for whom medications were reduced or discontinued 8. As shown in Figure 7A, the incidence of VF recurrence in the CAS group is consistent with that reported in previous studies 8, 21.…”

Section: Discussionsupporting

confidence: 83%

“…However, patients with CAS with aborted sudden cardiac arrest have been linked to a poor prognosis compared with those without such a condition 8, 21. Ahn et al demonstrated that patients with CAS with a history of aborted sudden cardiac death remain at high risk despite antianginal therapy 21.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of CAS in patients resuscitated from cardiopulmonary arrest ranges from 3.3% to 8.6% 3, 4, 5, 6. It is known that CAS may induce fatal ventricular arrhythmias without apparent chest symptoms 7, 8. In addition, inferolateral J wave has been associated with an increased risk of fatal ventricular arrhythmias in patients with CAS 9, 10, 11.…”

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confidence: 99%

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Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Kamakura

Wada

Ishibashi

et al. 2018

JAHA

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BackgroundPreviously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave).Methods and ResultsThe study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow‐up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF.ConclusionsApproximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Kamakura

Wada

Ishibashi

et al. 2018

JAHA

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“…9 In particular, the indication of ICD for the secondary prevention of lethal VAs because of CAS is controversial because CAS could be effectively suppressed by optical medications with calcium channel blockers (CCBs). [10][11][12][13] In the present study, we, thus, examined the long-term prognosis of patients with OHCA classified based on the results of the dual induction tests for CAS and lethal VAs and evaluated the necessity of ICD by the underlying mechanisms involved.…”

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confidence: 99%

Usefulness of Testing for Coronary Artery Spasm and Programmed Ventricular Stimulation in Survivors of Out-of-Hospital Cardiac Arrest

Komatsu

Takahashi

Fukuda

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Optimal therapy for patients resuscitated from out-of-hospital cardiac arrest (OHCA) who are not found to have structural heart disease remains to be established, especially regarding the use of implantable cardioverterdefibrillators. Coronary artery spasm (CAS) and lethal ventricular arrhythmias are important causes of OHCA. Methods and Results-In 47 consecutive OHCA survivors without structural heart disease who had fully recovered (M/F 44/3, 43±13 years.), we performed dual induction tests, including acetylcholine provocation test first followed by programmed ventricular stimulation after 1 to 2 weeks. Patients with CAS were treated with calcium channel blockerbased antianginal medications; implantable cardioverter-defibrillators were implanted in all patients. The results of the dual induction tests defined 4 groups: CAS alone (n=7), inducible ventricular arrhythmias alone (n=13), both positive (n=24), and both negative (n=3). During a median follow-up period of 38 months, ventricular fibrillation recurred in all groups except the both-negative group. Of the 16 patients with a type I Brugada ECG, 2 had CAS alone, 8 had ventricular arrhythmias alone, and 6 had both positive. No ventricular fibrillation episodes were observed in the CAS-alone patients who did not also have Brugada syndrome. Kaplan-Meier analysis showed that the CAS-alone group was at lower risk for OHCA recurrence as compared with the Brugada syndrome group (log-rank test; P=0.036). Conclusions-Among OHCA survivors without structural heart disease, provokable CAS and ventricular arrhythmias are common and can be seen in Brugada syndrome. CAS alone without Brugada syndrome who are treated for CAS may be a lower-risk group. (Circ Arrhythm Electrophysiol. 2016;9:e003798.

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Long-term Survival After Out-of-Hospital Cardiac Arrest

et al. 2022

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IMPORTANCE Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce.OBJECTIVE To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA.DATA SOURCES A systematic search of the EMBASE and MEDLINE databases was performed from database inception to March 25, 2021.STUDY SELECTION Clinical studies reporting long-term survival after OHCA were selected based on predefined inclusion and exclusion criteria according to a preregistered study protocol.DATA EXTRACTION AND SYNTHESIS Patient data were reconstructed from Kaplan-Meier curves using an iterative algorithm and then pooled to generate survival curves. As a separate analysis, an aggregate data meta-analysis was performed. MAIN OUTCOMES AND MEASURESThe primary outcome was long-term survival (>12 months) after OHCA for patients surviving to hospital discharge or 30 days after OHCA. RESULTSThe search identified 15 347 reports, of which 21 studies (11 800 patients) were included in the Kaplan-Meier-based meta-analysis and 33 studies (16 933 patients) in an aggregate data meta-analysis. In the Kaplan-Meier-based analysis, the median survival time for patients surviving to hospital discharge was 5.0 years (IQR, 2.3-7.9 years). The estimated survival rates were 82.8% (95% CI, 81.9%-83.7%) at 3 years, 77.0% (95% CI, 75.9%-78.0%) at 5 years, 63.9% (95% CI, 62.3%-65.4%) at 10 years, and 57.5% (95% CI, 54.8%-60.1%) at 15 years. Compared with patients with a nonshockable initial rhythm, patients with a shockable rhythm had a lower risk of long-term mortality (hazard ratio, 0.30; 95% CI, 0.23-0.39; P < .001). Different analyses, including an aggregate data meta-analysis, confirmed these results. CONCLUSIONS AND RELEVANCEIn this comprehensive systematic review and meta-analysis, long-term survival after 10 years in patients surviving the initial hospital stay after OHCA was between 62% and 64%. Additional research is needed to understand and improve the long-term survival in this vulnerable patient population.

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Clinical Characteristics and Long-Term Prognosis of Vasospastic Angina Patients Who Survived Out-of-Hospital Cardiac Arrest

Cited by 173 publications

References 41 publications

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Usefulness of Testing for Coronary Artery Spasm and Programmed Ventricular Stimulation in Survivors of Out-of-Hospital Cardiac Arrest

Long-term Survival After Out-of-Hospital Cardiac Arrest

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