J Korean Med Sci.  2020 Apr;35(19):e131. 10.3346/jkms.2020.35.e131.

Vasospasm-related Sudden Cardiac Death Has Outcomes Comparable with Coronary Stenosis in Out-of-Hospital Cardiac Arrest

• Lee DH
• Lee BK
• Kim YH
• Park YS
• Sim MS
• Kim SJ
• Oh SH
• Lee DH
• Kim YJ
• Kim WY

• KMID: 2500630
• DOI: http://doi.org/10.3346/jkms.2020.35.e131

Abstract

Background
Characteristics of coronary vasospasm-related sudden cardiac death are not well understood. We aimed to compare the characteristics and clinical outcomes between coronary vasospasm and stenosis, in out-of-hospital cardiac arrest (OHCA) survivors, who underwent coronary angiogram (CAG).
Methods
We conducted a multicenter retrospective observational registry-based study at 8 Korean tertiary care centers. Data of OHCA survivors undergoing CAG between 2010 and 2015 were extracted. Patients were divided into vasospasm and stenosis (stenosis > 50%) groups based on CAG findings. The primary and the secondary outcomes were survival and a good neurologic outcome at 30 days after OHCA. Patients in the vasospasm and stenosis groups were propensity score matched.
Results
Of the 413 included patients, vasospasm and stenosis groups comprised 87 and 326 patients, respectively. There were 279 (66.7%) survivors and 206 (49.3%) patients with good neurologic outcomes. The vasospasm group had better clinical characteristics for outcome (younger age, less diabetes and hypertension, more prehospital restoration of spontaneous circulation, higher Glasgow Coma Scale, less ST segment elevation, and less requirement of circulatory support). The vasospasm group had better survival (75/87 vs. 204/326, P < 0.001) and good neurologic outcomes (62/87 vs. 144/326, P < 0.001). However, vasospasm was not independently associated with survival (odds ratio [OR], 0.980; 95% confidence interval [CI], 0.400–2.406) or neurologic outcomes (OR, 0.870; 95% CI, 0.359–2.108) after adjustment and vasospasm was not associated with survival and neurologic outcome in propensity score-matched cohorts.
Conclusion
Our analysis of propensity score-matched cohorts finds that vasospasm OHCA survivors have survival and neurologic outcomes comparable with those of stenotic OHCA survivors.

Keyword

Out-of-Hospital Cardiac Arrest; Coronary Vasospasm; Coronary Stenosis; Prognosis

Figure

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  Fig. 1 Flow diagram of included patients.OHCA = out-of-hospital cardiac arrest, CAG = coronary angiogram, CABG = coronary artery bypass graft.

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  Fig. 2 Survival and good neurologic outcome on 30 days after cardiac arrest between out-of-hospital cardiac arrest survivors with coronary vasospasm and with coronary stenosis. (A) Vasospasm group has higher survival and good neurologic outcome in the whole cohort. (B) Survival and neurologic outcome are not different between vasospasm and stenosis groups in the propensity score-matched cohort.

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  Fig. 3 Kaplan-Meier plots until occurrence of all causes of mortality during 30 days after cardiac arrest in the vasospasm and stenosis groups. (A) The vasospasm group has higher cumulative survival than the stenosis group (P < 0.001) in the whole cohort. (B) Vasospasm and stenosis groups have similar cumulative survival in the propensity score-matched cohort (P = 0.299).

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