Variant Angina and Aborted Sudden Cardiac Death

  • Amartya Kundu
  • Aditya Vaze
  • Partha Sardar
  • Ahmed Nagy
  • Wilbert S. Aronow
  • Naomi F. Botkin
Ischemic Heart Disease (D Mukherjee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Ischemic Heart Disease


Purpose of Review

Variant angina, which is characterized by recurrent chest pain and transient ECG changes along with angiographic evidence of coronary artery spasm, generally has a favorable prognosis. However, episodes of ischemia caused by vasospasm may lead to potentially life-threatening ventricular arrhythmias and cardiac arrest, even in patients with no history of prior cardiac disease. This review describes the epidemiology, pathogenesis, clinical spectrum, and management of variant angina, as well as outcomes in patients who present with aborted sudden cardiac death (ASCD).

Recent Findings

Contrary to prior opinions, evidence from recent observational studies indicate that patients with variant angina presenting with ASCD face a worse prognosis than those without this type of presentation. Predictors of ASCD include age, hypertension, hyperlipidemia, family history of sudden cardiac death, multi-vessel spasm, and left anterior descending artery spasm. Medical therapy alone with calcium channel blockers and nitrates may not be sufficiently protective in these patients and there is lack of concrete data on the optimal management strategy. Current guidelines recommend implantable cardiac defibrillator (ICD) therapy in patients who are survivors of cardiac arrest caused by ventricular fibrillation or unstable ventricular tachycardia after reversible causes are excluded, and should strongly be considered in these patients.


Although medical therapy is absolutely imperative for patients with variant angina and a history of ASCD, ICD therapy in these patients is justified. Further large-scale studies are required to determine whether ICD therapy can improve survival in this high-risk group of patients.


Variant angina Coronary vasospasm Sudden death Cardiac arrest 


Compliance with Ethical Standards

Conflict of Interest

Amartya Kundu, Aditya Vaze, Partha Sardar, Ahmed Nagy, Wilbert S. Aronow, and Naomi F. Botkin declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Amartya Kundu
    • 1
  • Aditya Vaze
    • 2
  • Partha Sardar
    • 3
  • Ahmed Nagy
    • 2
  • Wilbert S. Aronow
    • 4
  • Naomi F. Botkin
    • 1
  1. 1.Department of Cardiovascular MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  3. 3.Department of CardiologyUniversity of Utah School of MedicineSalt Lake CityUSA
  4. 4.Department of CardiologyWestchester Medical CenterValhallaUSA

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