Author + information
- Philippe DEGRELL1,
- Julien Adjedj1,
- Hamid Aoumeur1,
- Antoine Navarro1,
- Florence Dumas1,
- Alain Cariou1 and
- OLIVIER VARENNE1
Systematic emergency coronary angiography for out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation remains debatable. We investigated the value of optical coherence tomography (OCT) to detect plaque rupture or intracoronary thrombus in these patients after return of spontaneous circulation (ROSC).
In our center, all OHCA patients without obvious extracardiac cause undergo systematic emergency coronary angiography irrespective of ECG findings. In patients with mild coronary atheroma, 3-vessel OCT was performed followed by percutaneous coronary intervention if plaque rupture or acute thrombosis were detected.
Between February and June 2016, 30 patients were included. Among the 27 patients without ST-segment elevation after ROSC, 16 had angiographically normal coronary arteries, 2 had acute coronary occlusion and 9 had mild coronary atheroma. OCT revealed coronary plaque rupture and/or thrombus (Figure) in 5 of the patients with mild coronary atheroma (56%). They subsequently underwent immediate angioplasty of the identified lesion. No complications occurred due to intravascular imaging.
Plaque rupture or acute coronary thrombosis was observed on OCT in around 25% of our all-comers population of consecutive OHCA patients without ST-segment elevation, and in up to 56% of those with mild coronary atheroma. Thus, one out of four OHCA patients without ST-segment elevation after ROSC had an acute coronary syndrome which would not have been diagnosed without systematic coronary angiography and intracoronary imaging.