title: Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death.
abstract: The long-term prognosis of patients with variant angina presenting with aborted sudden cardiac death (ASCD) is unknown.
  
  
  
  The purpose of this study was to evaluate the long-term mortality and ventricular tachyarrhythmic events of variant angina with and without ASCD.
  
  
  
  Between March 1996 and September 2014, 188 patients with variant angina with ASCD and 1,844 patients with variant angina without ASCD were retrospectively enrolled from 13 heart centers in South Korea. The primary endpoint was cardiac death.
  
  
  
  Predictors of ASCD manifestation included age (odd ratio [OR]: 0.980 by 1 year increase; 95% confidence interval [CI]: 0.96 to 1.00; p = 0.013), hypertension (OR: 0.51; 95% CI: 0.37 to 0.70; p < 0.001), hyperlipidemia (OR: 0.38; 95% CI: 0.25 to 0.58; p < 0.001), family history of sudden cardiac death (OR: 3.67; 95% CI: 1.27 to 10.6; p = 0.016), multivessel spasm (OR: 2.06; 95% CI: 1.33 to 3.19; p = 0.001), and left anterior descending artery spasm (OR: 1.40; 95% CI: 1.02 to 1.92; p = 0.04). Over a median follow-up of 7.5 years, the incidence of cardiac death was significantly higher in ASCD patients (24.1 per 1,000 patient-years vs. 2.7 per 1,000 patient-years; adjusted hazard ratio [HR]: 7.26; 95% CI: 4.21 to 12.5; p < 0.001). Death from any cause also occurred more frequently in ASCD patients (27.5 per 1,000 patient-years vs. 9.6 per 1,000 patient-years; adjusted HR: 3.00; 95% CI: 1.92 to 4.67; p < 0.001). The incidence rate of recurrent ventricular tachyarrhythmia in ASCD patients was 32.4 per 1,000 patient-years, and the composite of cardiac death and ventricular tachyarrhythmia was 44.9 per 1,000 patient-years. A total of 24 ASCD patients received implantable cardioverter-defibrillators (ICDs). There was a nonsignificant trend of a lower rate of cardiac death in patients with ICDs than those without ICDs (p = 0.15).
  
  
  
  The prognosis of patients with variant angina with ASCD was worse than other patients with variant angina. In addition, our findings supported ICDs in these high-risk patients as a secondary prevention because current multiple vasodilator therapy appeared to be less optimal.
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.affiliation: Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Ki Hong
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea.
authors.forename: Sang-Yong
authors.initials: SY
authors.lastname: Yoo
authors.affiliation: Department of Cardiology, Dong-A University Hospital, Busan, South Korea.
authors.forename: Young-Rak
authors.initials: YR
authors.lastname: Cho
authors.affiliation: Department of Cardiology, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea.
authors.forename: Jon
authors.initials: J
authors.lastname: Suh
authors.affiliation: Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Shin
authors.affiliation: Department of Cardiology, Chungnam National University Hospital, Daejeon, South Korea.
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea.
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Shin
authors.affiliation: Department of Cardiovascular Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Sung-Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Keimyung University Dongsan Medical Center, Daegu, South Korea.
authors.forename: Sang Hong
authors.initials: SH
authors.lastname: Baek
authors.affiliation: Department of Cardiovascular Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.affiliation: Keimyung University Dongsan Medical Center, Daegu, South Korea.
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.affiliation: Kyung Hee University Hospital, Gangdong, Seoul, South Korea.
authors.forename: Eun-Sun
authors.initials: ES
authors.lastname: Jin
authors.affiliation: Department of Cardiology, Soonchunhyang University Hospital Cheonan, Cheonan, South Korea.
authors.forename: Se-Whan
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Pusan National University Hospital, Busan, South Korea.
authors.forename: Jun-Hyok
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Jang
authors.affiliation: Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Park
authors.affiliation: Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Nam Sik
authors.initials: NS
authors.lastname: Yoon
authors.affiliation: Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Jeong Gwan
authors.initials: JG
authors.lastname: Cho
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Pusan National University Hospital, Busan, South Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Ki-Byung
authors.initials: KB
authors.lastname: Nam
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: kjchoi@amc.seoul.kr.
authors.forename: Kee-Joon
authors.initials: KJ
authors.lastname: Choi
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: You-Ho
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: sjpark@amc.seoul.kr.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000788:Angina Pectoris, Variant / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors
keywords: angina; cardiac arrest; coronary spasm; vasospastic angina; ventricular tachyarrhythmic