Abstract 317: The Clinical Features and Outcomes of Vasospastic Angina in Patients Survived Out-of-Hospital Cardiac Arrest

Abstract

Introduction: Acute myocardial infarction (AMI) is a major cause of cardiac arrest. Coronary vasospasm has been suggested to play a significant role in the acute phase of MI. Vasospastic angina (VSA) is characterized by spontaneous attacks of chest pain, caused by transient coronary vasospasm. Severe coronary vasospasm might cause AMI, fatal arrhythmia, and subsequent cardiac arrest, however, there have been limited studies about the clinical characteristics and prognosis of patients with VSA regarding cardiac arrest. This study investigated the clinical features and outcomes of VSA compared to other MI in patients survived out-of-hospital cardiac arrest (OHCA). Method and Results: We analyzed the data of adult OHCA patients from the prospectively collected post cardiac arrest syndrome (PCAS) registry of 3 urban academic hospitals from December 2013 to December 2017. During the study period, 721 OHCAs were collected, including 18 diagnosed with VSA and 133 with other MI as primary cause of cardiac arrest. Compared to other MI, more patients achieved pre-hospital return of spontaneous circulation (ROSC) in VSA group (72.2% vs. 47.4%, p =0.041). The advanced cardiovascular life support (ACLS) time (median, 4.0 min vs. 10.0 min; p =0.008) was shorter in VSA group. The SOFA (5.0 vs. 9.0, p =0.007) and APACHE II score (20.5 vs. 25.0, p =0.007) at admission were lower in VSA group. The proportion of the patients who underwent coronary angiography (CAG) did not differ between the two groups and there were no patients with a newly diagnosed coronary obstructive lesion in CAG performed after ROSC. More patients in VSA group had good neurologic outcome at hospital discharge (77.8% vs. 47.3%, p =0.022), 28 days (76.5% vs. 48.4%, p =0.038), and 6 months (76.5% vs. 47.7%, p =0.037). All-cause mortality rate at in-hospital (5.6% vs. 42.1%, p =0.002) and 28 days (11.2% vs. 44.5%, p =0.009) were lower in VSA group. In the subgroup analysis of patients who underwent CAG, more patients with VSA showed lower mortality rate at in-hospital (0.0% vs. 35.4%, p =0.003) and 28 days (6.7% vs. 38.0%, p =0.019). Conclusion: In patients survived OHCA, patients with VSA more achieved pre-hospital ROSC and showed better neurologic outcome and lower mortality rate compared to those with other MI.