Variant Angina and Aborted Sudden Cardiac Death
What are the long-term mortality and ventricular tachyarrhythmic events of variant angina with and without aborted sudden cardiac death (ASCD)?
This was a multicenter retrospective analysis, conducted between 1996 and 2014, of 188 variant angina patients with ASCD, and 1,844 variant angina patients without ASCD in South Korea. The primary endpoint was cardiac death.
Median follow-up was 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% confidence interval [CI], 4.21-12.5; p < 0.001). A total of 24 ASCD patients received implantable cardioverter-defibrillators (ICDs). During follow-up, there was a nonsignificant trend of a lower rate of cardiac death in patients with an ICD than those without an ICD.
Among variant angina patients, the incidence of cardiac death was significantly higher in ASCD patients than in those who did not experience ASCD.
Although limited by a retrospective design, this analysis provides insight into management of patients with variant angina who experience ASCD. Although there is equipoise about management of ASCD in these patients (based on the premise that coronary spasm is a process reversible with vasodilator therapy), the authors provide a convincing argument for ICD therapy for secondary prevention.
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