Questionnaire in patients with aborted sudden cardiac death due to coronary spasm in Japan
Questionnaire in patients with aborted sudden cardiac death due to coronary spasm in Japan
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DOI：
10.1007/s00380-020-01644-7
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发表时间：
2020-06-12
影响因子：
1.5
通讯作者：
Tsujita, Kenichi
中科院分区：
文献类型：
--
作者：
Sueda, Shozo;Shinohara, Tetsuji;Tsujita, Kenichi
目的探讨日本心脏病专家对冠状动脉痉挛引起的心脏性猝死（ASCD）的药物或机械治疗以及目前的认识。方法采用问卷调查的方法，对ASCD患者中因冠状动脉痉挛而发生ASCD、植入型心律转复除颤器（ICD）和药物治疗的病例数进行调查。问卷被随机发送到204家心脏病医院的日本综合机构。结果34家医院回收问卷，回收率为16.7%。在5726例患者中观察到5年期间的所有SCD。在808例患者（14.0%）中发现可能由冠状动脉痉挛引起的SCD，在169例患者（20.9%）中观察到由冠状动脉痉挛引起的ASCD。在169例冠状动脉痉挛导致的ASCD患者中，三分之二的患者[113例患者（66.9%）]使用了1种或2种冠状动脉扩张剂，而56例患者（33.1%）使用了3种以上的冠状动脉扩张剂。其中117例因冠脉痉挛而植入ICD，其中35例植入皮下ICD。ASCD的主要原因是室颤，而18例患者中观察到无脉性电活动，7例患者中发现完全性房室传导阻滞。有ICD的ASCD患者的平均冠状动脉扩张血管数显著低于无ICD的患者（2.1 ± 0.9 vs.2.6 ± 1.0，p < 0.001）。尽管16家机构认为药物下的痉挛激发试验在抑制下一次致命性心律失常方面具有一定的临床意义，但仅在4家机构中进行了药物下的痉挛激发试验。结论在真实的世界中，对于冠状动脉痉挛导致的ASCD患者没有基本的治疗策略。每个机构都有针对这些患者的策略。心脏科医生应该有相同的策略和相同的知识ASCD患者由于冠状动脉痉挛在未来。
Objectives We investigated the medical or mechanical therapy, and the present knowledge of Japanese cardiologists about aborted sudden cardiac death (ASCD) due to coronary spasm. Methods A questionnaire was developed regarding the number of cases of ASCD, implantable cardioverter-defibrillator (ICD), and medical therapy in ASCD patients due to coronary spasm. The questionnaire was sent to the Japanese general institutions at random in 204 cardiology hospitals. Results The completed surveys were returned from 34 hospitals, giving a response rate of 16.7%. All SCD during the 5 years was observed in 5726 patients. SCD possibly due to coronary spasm was found in 808 patients (14.0%) and ASCD due to coronary spasm was observed in 169 patients (20.9%). In 169 patients with ASCD due to coronary spasm, one or two coronary vasodilators was administered in two-thirds of patients [113 patients (66.9%)], while more than 3 coronary vasodilators were found in 56 patients (33.1%). ICD was implanted in 117 patients with ASCD due to coronary spasm among these periods including 35 cases with subcutaneous ICD. Majority of cause of ASCD was ventricular fibrillation, whereas pulseless electrical activity was observed in 18 patients and complete atrioventricular block was recognized in 7 patients. Mean coronary vasodilator number in ASCD patients with ICD was significantly lower than that in those without ICD (2.1 +/- 0.9 vs. 2.6 +/- 1.0,p < 0.001). Although 16 institutions thought that the spasm provocation tests under the medications had some clinical usefulness of suppressing the next fatal arrhythmias, spasm provocation tests under the medication were performed in just 4 institutions. Conclusions In the real world, there was no fundamental strategy for patients with ASCD due to coronary spasm. Each institution has each strategy for these patients. Cardiologists should have the same strategy and the same knowledge about ASCD patients due to coronary spasm in the future.