THE ROLE OF CORONARY ARTERY SPASM IN SUDDEN CARDIAC DEATH AMONG YOUNG ADULTS

Abstract

Sudden cardiac death (SCD) in young adults presents a major clinical and public health challenge, often occurring in the absence of structural heart disease. This study investigates the role of coronary artery spasm (CAS) as a potential etiology of SCD in individuals aged 18–35, using a mixed-method approach combining retrospective clinical analysis, prospective diagnostic testing, and qualitative interviews. Among 200 young adult patients presenting with symptoms suggestive of CAS or unexplained cardiac arrest, 72% reported chest pain at rest, while 61% demonstrated ST-segment elevation on ECG. Provocative testing confirmed CAS in 52% of patients through acetylcholine challenge, despite 45% showing angiographically normal coronary arteries. Logistic regression identified smoking (OR: 2.3), stimulant use (OR: 3.1), prior syncope (OR: 2.5), and male gender (OR: 1.7) as significant predictors of CAS-related events. Medication analysis revealed that calcium channel blockers and nitrates resulted in the highest symptom improvement rates (74% and 59%, respectively).The statistics revealed that SCD affected 6% of patients during follow-up and about 30% of patients experienced repeated symptoms. The majority of the remaining participants experienced complete recovery.  Participants in the interviews attributed the instances of CAS to inadequate understanding of risk, delayed reactions upon first experiencing symptoms and mistaken interpretations of those initial signs.  These findings emphasise the significant contribution of CAS as a frequently disregarded underlying condition of arrhythmia and sudden cardiac death in the young adult population, particularly when symptoms suggest acquired heart disease.  The findings emphasize the need for targeted risk identification, timely identification and incorporation of provocative testing into diagnostic evaluation.  Both therapeutic interventions and public education campaigns play important roles in averting potentially fatal consequences in young adults.  Congenital anomalies of the coronary arteries should be considered by physicians during the regular examination of young adults.