ANGINA-LINKED SYNCOPE AND LACK OF CALCIUM-ANTAGONIST THERAPY PREDICT CARDIAC-ARREST BEFORE DEFINITIVE DIAGNOSIS OF VASOSPASTIC ANGINA

Background: Several prognostic factors have been identified in patient s with vasospastic angina; however, factors that would predict potenti ally fatal cardiac arrest during the period between the onset of angin a and its definitive diagnosis remain unknown. We investigated the pre dictive value of the clinical findings that are available when a patie nt is hospitalized after a cardiac arrest but before a definitive diag nosis of vasospastic angina is made. Methods: We compared the clinical findings in 11 patients who experienced cardiac arrest before vasospa stic angina was definitively diagnosed (group I) with 81 patients with vasospastic angina without cardiac arrest (group II). The definitive diagnosis of vasospastic angina was made on the basis of results of co ronary spasm provocation test or ECGs during spontaneous attacks, or b oth. Results: The incidence of angina-linked syncope was significantly higher in group I than in group II (six out of 11 versus nine out of 81, P<0.005). Significantly fewer group I patients were receiving calc ium antagonists than group Il patients (three out of 11 versus 63 out of 81, P<0.005). Serious arrhythmias were significantly more common in group I than in group II (seven out of 11 versus 12 out of 81, P<0.00 5). Logistic regression analysis of the eight clinical variables avail able when first seen in the hospital indicated that angina-linked sync ope and the lack of calcium antagonist therapy were independently rela ted to risk of cardiac arrest. Conclusions: From the clinical findings available, a history of angina-linked syncope and lack of calcium ant agonist therapy were found to be independent predictors of cardiac arr est before a definitive diagnosis had been made. Patients who have sus pected vasospastic angina may benefit from early treatment with calciu m antagonists if they have a history of angina-linked syncope.