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

Authors
Lee, Dong HunLee, Byung KookKim, Yong HwanPark, Yoo SeokSim, Min SeobKim, Su JinOh, Sang HoonLee, Dong HoonKim, Youn-JungKim, Won Young
Issue Date
18-5월-2020
Publisher
KOREAN ACAD MEDICAL SCIENCES
Keywords
Out-of-Hospital Cardiac Arrest; Coronary Vasospasm; Coronary Stenosis; Prognosis
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v.35, no.19
Indexed
SCIE
SCOPUS
KCI
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
Volume
35
Number
19
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/55668
DOI
10.3346/jkms.2020.35.e131
ISSN
1011-8934
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.
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