Does Coronary Vasospasm Show a Better Prognosis in Out of Hospital Cardiac Arrest: Data from the Korean Cardiac Arrest Research Consortium (KoCARC) Registry

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 coronary 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.