title: Clinical characteristics and long-term prognosis of vasospastic angina patients who survived out-of-hospital cardiac arrest: multicenter registry study of the Japanese Coronary Spasm Association.
abstract: 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.
  
  
  RESULTS
  Between 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; P<0.001) and higher incidence of left anterior descending coronary artery spasm (72% versus 53%, P<0.05). 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, P<0.001), 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; P<0.01).
  
  
  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.
authors.affiliation: Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takagi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Tsunoda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogata
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Matsui
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Goto
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tanabe
authors.forename: Shozo
authors.initials: S
authors.lastname: Sueda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogawa
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kubo
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Momomura
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimokawa
mesh_terms: D000368:Aged; D002309:Cardiology; D003329:Coronary Vasospasm / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012955:Societies, Medical / Q000706:statistics & numerical data*; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors