Vasospastic angina (VSA) is a common disease that causes rest/effort angina attacks globally. Coronary spasms occur in patients with and without atherosclerotic coronary stenosis based on the underlying causative mechanisms and triggers. The first-line and effective treatments, which are calcium channel blockers and nitrates, have been established as shown in the multiple guidelines. However, it is also well known that some refractory VSA patients do not respond to standard therapy and remain to complain of angina symptom. Furthermore, severe clinical manifestations such as acute coronary syndrome and lethal arrhythmia may occur, which often disturb daily life. Thus, additional personalized treatments for individual refractory VSA patient are mandatory. Although scientific reports with a high level of evidence regarding treatments for refractory VSA are limited, a significant number of reports have been published including case series reports that showed successful empirical treatments. Each therapy might not be appropriate for all patients but may be effective for patients with specific characteristics owing to the mechanism and trigger of spasm. In this review, the optional pharmacological and invasive treatments for refractory VSA are described.
Objectives: We retrospectively analyzed the clinical and angiographical characteristics between variant angina and non-variant angina. Methods: We diagnosed 902 patients with coronary spastic angina from Jan 1991 to Mar 2019. Variant angina was observed in 105 patients, while the remaining 797 patients had non-variant angina. Acetylcholine was injected in incremental doses of 20/50/100/200 μg into the left coronary artery (LCA) and 20/50/80 μg into the right coronary artery (RCA), whereas 64 μg ergonovine was administered into the LCA and 40 μg into the RCA. Positive spasm was defined as > 90% stenosis and usual chest pain or ischemic ECG changes. Clinical outcomes under medications were investigated during 1462±960 days of follow-up. Results: There were no differences regarding the clinical characteristics between the two groups. Significant organic stenosis was frequently observed in patients with variant angina compared with non-variant angina. Although the administration of two types of calcium channel blocker (CCB)s, nitrates, and aspirin was markedly higher in patients with variant angina than in those with non-variant angina, the number of clinical outcomes including sudden cardiac death, acute coronary syndrome, ventricular fibrillation, and percutaneous coronary intervention was significantly higher in patients with variant angina than in those with non-variant angina. Clinical outcomes in patients with variant angina and organic stenosis was markedly worse than other 3 groups: variant angina with nonorganic stenosis, non-variant angina with organic stenosis, and non-variant angina and nonorganic stenosis. Conclusions: Clinical outcomes in patients with variant angina was unfavorable compared with those with non-variant angina. Variant angina requires more percutaneous coronary intervention therapy compared with non-variant angina.
Background: Although approximately 120,000 out-of-hospital cardiac arrests (OHCAs) occur annually in Japan, the rate of favorable neurological outcomes after cardiogenic cardiac arrests witnessed by the public is only 7–8%. There are approximately 600,000 automated external defibrillators (AEDs) deployed nationwide, but the rate of AED use in patients with a publicly witnessed cardiac arrest is as low as 4.9%. Methods: The Kento Heart Safe City Project is designed to increase the rate of AED use, reduce sudden cardiac deaths, and improve the rate of favorable neurological outcomes by using a newly developed emergency call button (SOS button by Philips Japan, Ltd.). This project includes training and properly deploying community first responders and developing an education and rapid notification system in an integrated manner. The SOS button is an Internet of Things (IoT) device and uses the same radio waves as cell phones; pressing the SOS button triggers the communication system. Discussion: Compared to ordinary emergency systems, the SOS button is a unique rescue system based on the premise of voluntary mutual aid. It is necessary to verify how many first responders will respond to SOS requests and how long it will take for responders to arrive at the scene.