Abstract 17851: Prognostic Factors and Outcomes of Patients With Vasospastic Angina Surviving Out-of-hospital Cardiopulmonary Arrest

Abstract

Background: Vasospastic angina (VSA) is reported to cause sudden cardiac death (SCD) due to lethal ventricular arrhythmias, even while a patient is undergoing drug therapy with calcium channel blockers (CCB). The prognostic factors are not fully assessed and the indication of implantable cardioverter-defibrillator (ICD) for patients with VSA is still controversial. We assessed the prognostic factors and outcomes of patients with VSA surviving out-of-hospital cardiopulmonary arrest (OHCA). Methods: Between November 2007 and February 2014, 129 VSA patients were diagnosed by provocative tests using ergonovine during coronary angiographies. The patients were divided into two groups: OHCA group consisted of patients with VSA surviving OHCA (n=15, median age: 58.2 ± 12.2 years) and non-OHCA group (n=114, median age: 60.3 ± 0.9 years). We analyzed the appearance of J wave in the resting ECG and T wave augmentation (more than two times compared to resting) during treadmill exercise tests in three groups (OHCA group, non-OHCA group and Control group consisting of healthy subjects (n=25, median age: 57.9 ± 1.8years)). Results: In resting ECG analysis, J wave was found in 9/15 (60%) of OHCA group, 42/114 (37%) of non-OHCA group and 3/25 (12%) of Control group. There was no significant difference in the appearance of J wave among the three groups. In ECG analysis of treadmill exercise tests, T wave augmentation in non-OHCA group (15/38, 39%) was significantly more frequent than that of Control group (3/25, 12%) (p=0.04). Furthermore T wave augmentation in OHCA group (10/12, 83%) was significantly more frequent than that of non-OHCA group (p=0.008). In OHCA group, all patients began treatment with CCB. Twelve of 15 patients (87%) underwent ICD therapy. During a follow up of 38.7 ± 18.4 months, three of 15 patients (20%) in OHCA group had appropriate ICD therapy or died: one patient received an appropriate ICD therapy for VF and successfully resuscitated, and two patients died suddenly among 3 patients without ICD implantations. Conclusions: In the risk stratification of SCD in VSA patients, T wave augmentation during treadmill exercise tests might be a new prognostic factor. ICD might result in favorable clinical outcomes for high-risk VSA patients.