, Sang Hoon Na 2
, Sang Do Shin 3
, Jin Wi 4
, Sang-Hyun Kim 5
, Jinho Choi 6
, Jong-Il Choi 7
, Youngjin Cho 8
, Myung-Jin Cha 2
, Kyung-Hee Kim 9
2Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea
3Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
4Department of Internal Medicine, Division of Cardiology, Gachon University Gil Medical Center, Seoul, Korea
5Department of Internal Medicine, Division of Cardiology, Seoul National University Boramae Medical Center, Seoul, Korea
6Department of Internal Medicine, Division of Cardiology, Samsung Medical Center, Seoul, Kore
7Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
8Department of Internal Medicine, Division of Cardiology, Seoul National University Bundang Hospital, Seoul, Korea
9Department of Internal Medicine, Division of Cardiology, Sejong General Hospital, Seoul, Korea
Abstract
Background: Previous cohort studies focused on relative risk stratification among patients diagnosed with vasospastic angina, and it is unknown how much vasospasm accounts for the cause of out-of-hospital cardiac arrest, and whether prognosis differs.
Methods: From a registry data collected from 65 hospitals in Korea, 863 subjects who survived hospital cardiac arrest were evaluated. The patients with insignificant coro-nary lesion, vasospasm, and obstructive lesion were each grouped as group I, group II, and group III, respectively. The primary and secondary outcomes were survival to hospital discharge and good neurological function at discharge defined as cerebral performance index 1.
Results: At hospital discharge, 529 subjects (61.3%) survived. There was no significant difference in survival according to coronary angiographic findings (P =.133 and P =.357, group II and group III compared to group I), but the neurological outcome was significantly better in groups II and III (P =.046 and P =.022, groups II and III compared to group I). Two multivariate models were evaluated to adjust traditional risk factors and cardiac biomarkers. The presence of coronary artery vasospasm did not affect survival to hospital discharge (P = 0.060 and P =.162 for both models), but neurological function was significantly better (OR: 1.965, 95% CI: 1.048-3.684, P =.035, and OR: 1.706, 95% CI: 1.012-2.878, P =.045 for vasospasm, models I and II, respectively).
Conclusions: Coronary vasospasm does not show better survival to hospital discharge, but shows better neurological outcomes. Aggressive coronary angiography and intensive medical treatment for adequate control of vasospasm should be emphasized to prevent and manage fatal events.