Clinical Therapy in Patients with Aborted Sudden Cardiac Death due to Coronary Spasm

Abstract

Background: Coronary artery spasm may lead to the aborted sudden cardiac death (A-SCD). Objectives: We investigated the number of coronary vasodilators, including calcium channel blocker (CCB), implantable cardioverter-defibrillator (ICD) implantation and prognosis in patients with A-SCD due to coronary spasm in the real world. Methods: We recruited 98 patients (82 men, mean age of 59.6±13.3 years old) with A-SCD due to coronary spasm using a questionnaire. Results: Ventricular fibrillation (VF) as a cause of A-SCD was observed in 83 patients (84.7%), while pulseless electrical activity (PEA) was recognized in 12 patients (12.2%). ICD was implanted in 58 patients and appropriate ICD therapies were recognized in 8 patients (13.8%). There were no differences regarding medications between patients with and without ICD or between patients who survived and those who died. Mean follow-up duration was 27.1±19.9 months and three patients died. Mortality during the follow-up period was not different patients with ICD from those without ICD. The mean number of coronary vasodilators including CCB in patients with spasm provocation tests under medications were significantly higher than in those without. VF as an initial cause of A-SCD was recognized in all 3 patients who died, while PEA was a final cause of death in 2 of 3 patients. Conclusions: Clinical outcomes in patients with A-SCD due to coronary spasm is satisfactory under medical and mechanical therapy. Decision of requiring the ICD implantation in patients with A-SCD due to coronary spasm is a challenging clinical problem.

Does the intracoronary pressure differ according to two types (diffuse or focal) of coronary spasm?

“…However, several issues regarding coronary spasm are not fully understood or solved, including the protocol for the spasm provocation test (SPT), the sequence of SPT during comprehensive coronary angiography, the treatment of medically refractory coronary spasm, and the need for implantable cardioverter defibrillators in the event of cardiac arrest[ 2 - 6 ]. The endotype of coronary spasm as focal and diffuse spasm is one such unsolved problem regarding coronary spasm[ 5 ].…”