title: Sudden cardiac arrest and syncope triggered by coronary spasm.
abstract: BACKGROUND
  Patients with coronary spasm generally have a good prognosis, although it can result in sudden cardiac arrest (SCA) and syncope. We hypothesized that the nature of coronary spasm triggering lethal arrhythmias may be different from that which induces angina-only.
  
  
  METHODS
  Clinical characteristics were examined in patients who had experienced SCA (n = 18) or syncope (n = 28) triggered by coronary spasm. These characteristics were compared to those of patients who had coronary spastic angina-only (n = 52).
  
  
  RESULTS
  SCA and syncope occurred frequently during daytime in 57% and 68%, respectively. Spontaneous ST-segment changes during daytime were recorded more often in patients with SCA (50%) and syncope (39%) than angina-only patients (4%, p < 0.01 for each). Nocturnal angina occurred less frequently in patients with SCA (33%) and syncope (32%) than angina-only patients (83%, p < 0.01 for each). Severe multivessel spasm, daytime ST-segment changes, and younger age were significant predictors of SCA. Daytime ST-segment changes and active smoking were related to syncope.
  
  
  CONCLUSIONS
  The circadian variance of coronary spasm triggering SCA or syncope may be different from that inducing typical coronary spastic angina. The coronary spasm should be evaluated for patients with aborted SCA or recurrent syncope of unknown cause, even though the patients have not experienced the typical nocturnal angina.
authors.affiliation: Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Togashi
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sato
authors.forename: Kyoko
authors.initials: K
authors.lastname: Soejima
authors.forename: Seiji
authors.initials: S
authors.lastname: Takatsuki
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Miyoshi
authors.forename: Kotaro
authors.initials: K
authors.lastname: Fukumoto
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Nishiyama
authors.forename: Masaru
authors.initials: M
authors.lastname: Suzuki
authors.forename: Shingo
authors.initials: S
authors.lastname: Hori
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogawa
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000328:Adult; D000368:Aged; D003329:Coronary Vasospasm / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013575:Syncope / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology