Out-of-hospital cardiac arrest related to coronary arterial spasm in three elderly patients with no obstructive coronary artery disease

Abstract Coronary spastic angina (CSA) is relatively more common in young people than in elderly people. Here, we present three cases of elderly male patients who experienced out-of-hospital cardiac arrest (OHCA) likely due to coronary spasm-induced ventricular fibrillation (Vf) from 2013 to 2016. After defibrillation, emergency coronary arteriography demonstrated severe coronary vasospasm that resolved following intracoronary infusion of nitroglycerin in the right coronary arteries in all three patients, with no organic obstructive lesion in the coronary arteries after nitroglycerin infusion. Case 1 was a 74-year-old patient with a past history of unstable angina and no organic obstructive lesion on coronary arteriography. He was administered oral amlodipine, isosorbide mononitrate, and nicorandil. He survived an OHCA and underwent implantable cardioverter defibrillator (ICD) implantation on day 57. Case 2 was a 71-year-old patient without prior CSA, who suddenly lost consciousness during a break after tennis. Vf was reversed to sinus rhythm by defibrillation in the ambulance. He died of multi-organ failure on day 7. Case 3 was a 66-year-old patient diagnosed with multi-vessel CSA by coronary arteriography with acetylcholine provocation test. He survived an OHCA associated with inferior acute myocardial infarction, rejected ICD implantation, and has not had a chest pain attack or syncope since discharge. Learning objective: This article reports a case series of out-of-hospital cardiac arrest (OHCA) likely due to coronary spastic angina (CSA) in the presence of non-obstructive coronary artery disease in elderly patients. Although CSA is associated with an increased risk of OHCA, little is known regarding clinical risk factors, the effectiveness of implanted defibrillators for the secondary prevention of cardiac arrest, or the long-term prognosis of elderly CSA patients who survive OHCA.>