Sudden cardiac arrest and syncope triggered by coronary spasm

• Published in: International journal of cardiology Vol. 163; no. 1; pp. 56 - 60
• Main Authors: Togashi, Ikuko, Sato, Toshiaki, Soejima, Kyoko, Takatsuki, Seiji, Miyoshi, Shunichiro, Fukumoto, Kotaro, Nishiyama, Nobuhiro, Suzuki, Masaru, Hori, Shingo, Ogawa, Satoshi, Fukuda, Keiichi
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 10.02.2013; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Coronary spasm; Coronary Vasospasm - complications; Coronary Vasospasm - diagnosis; Coronary Vasospasm - epidemiology; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - etiology; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Heart; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Retrospective Studies; Sudden cardiac arrest; Syncope; Syncope - diagnosis; Syncope - epidemiology; Syncope - etiology; Sudden cardiac arrest; Coronary spasm; Syncope; Nervous system diseases; Cardiocirculatory arrest; Consciousness impairment; Coronary artery; Cardiovascular disease; Sudden; Coronary heart disease; Trigger; Spasm; Neurological disorder; Cardiology
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2011.05.055

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. 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). 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. 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.