P6005Incidence and clinical characteristics of coronary artery spasm in patients with out-of-hospital cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Kawamura ◽  
H Okayama ◽  
S Kido ◽  
T Aono ◽  
K Matsuda ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Artery Spasm ◽  
Coronary Spasm ◽  
Coronary Syndrome ◽  
Organic Heart Disease ◽  
Japanese Guideline ◽  
Hospital Cardiac Arrest

Abstract Background Substantial cases of out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome have been recognized thus far, but there have been few reports about the aetiology of patients with OHCA without the organic heart disease. Especially, coronary artery spasm would be one of the causes of OHCA. Purpose This study aimed to investigate causes of OHCA without the organic heart disease and to investigate the characteristics and angiographic findings of OHCA patients with vasospastic angina (VSA). Methods Between January 2010 and April 2018, 920 patients with OHCA caused by probable or definite cardiovascular disease were transferred to our hospital. Return of spontaneous contraction was successfully achieved in 151 patients, among whom diagnosis was made in 130 patients. First, we analysed the causes of OHCA in these patients. Second, we compared clinical and angiographic characteristics between the VSA group with OHCA (OHCA-VSA) and the VSA group without OHCA (stable VSA; n=72) from our database. Results Among the 130 patients, 95 (73%) had the organic heart disease; 72, acute coronary syndrome; 19, myocardial disease; 2, valvular heart disease; and 1, congenital heart disease. There were 35 patients (27%) without the organic heart disease. Nineteen patients had primary (i.e., Brugada syndrome, QT prolongation) or secondary arrhythmia (i.e. drug adverse effect). Electrocardiogram, coronary angiogram, and LV structure and function were normal in 35 patients. However, there were 16 patients (11%) with VSA defined by Japanese guideline. The OHCA-VSA group was significantly younger (50±14) than the stable VSA group (64±11, P=0.003). The incidence of diffuse-type spasm in the OHCA-VSA group (100%) was significantly higher than that in the stable VSA group (100% vs. 69%, P<0.05). In addition, the incidence of triple-vessel coronary spasm in the OHCA-VSA group was significantly higher than that in the stable VSA group (86% vs. 25%, P=0.003). Conclusion OHCA patients without the organic heart disease had considerable cases of VSA, in addition to primary or secondary arrhythmia. Furthermore, the severity of spasm in the OHCA-VSA group was more serious and extensive than in comparison with the stable VSA group.

6031Out -of-hospital cardiac arrest - incidence of coronary artery disease, co-morbidity and survival

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Soeholm ◽  
C Hassager ◽  
F Pedersen ◽  
U Abildgaard ◽  
S Haahr-Pedersen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Prognostic Factors ◽  
Coronary Artery ◽  
Urban Region ◽  
Coronary Syndrome ◽  
Total Cohort ◽  
Artery Disease ◽  
Hospital Cardiac Arrest

Abstract Background Data from the European Cardiovascular Disease Statistics from 2012 shows that 20% of all deaths are caused by coronary artery disease with cardiac arrest (CA) as the most common scenario. Historic data have shown that coronary artery disease was present in approximately 70% of unselected out-of-hospital CA (OHCA) patients byangiography. As registry and retrospective data are prone to bias it remains unknown whether an early invasive strategy translates into improved outcome, we present our experience from a large urban region of Denmark. Purpose The aim was to describe a consecutive OHCA-cohort with regards to incidence of coronary artery disease, comorbidity and survival rate. Methods A consecutive unselected cohort of patients with OHCA in the Capital Region of Denmark was included (n=1,003) from 2007 to 2011. After successful resuscitation patients were admitted for post-resuscitation care at 1 of 8 hospitals including coronary angiography and percutaneous coronary interventions (PCI) when indicated. Results Patients were 65±15 years old, 71% were male, 52% had shockable primary rhythm, median time to return of spontaneous circulation (ROSC) was 22 minutes (Q1–Q3: 13–37 min), the majority was unconscious at hospital admission (89%), and no previous comorbidity was noted in 52%. The majority of the cohort had OHCA due to a cardiac cause (n=806, 80%). Acute coronary syndrome (ACS) was diagnosed in 39% of the total cohort (n=389), and in 48% of patients with cardiac cause with ST-segment elevation myocardial infarction being more frequent (n=236, 60% of ACS). 30-day mortality was 59% in the total cohort and 46% in patients with ACS (plogrank<0.001). A favourable neurological outcome (Cerebral Performance Category 1 or 2) was noted in 84% of all patients discharged alive (n=347), and in 85% of patients with ACS (n=178). In the total cohort ACS was independently associated with a lower 30-day mortality rate (hazard ratio (HR) = 0.62, 95% confidence interval (CI) 0.51–0.75, p<0.001) after adjustment for age, pre-hospital OHCA circumstances (bystander CPR, public arrest and witnessed arrest), time to ROSC, primary admission to a tertiary heart centre, and degree of comorbidity. In OHCA-patients with ACS only, successful PCI was independently associated with a lower 30-day mortality after adjustment for the mentioned prognostic factors (HR all ACS= 0.46, 95% CI 0.31–0.67, p<0.001, HR STEMI= 0.43, 0.27–0.69, p<0.001, HR NSTEMI= 0.12, 0.03–0.51, p=0.004). Conclusion In an unselected clinical cohort of out-of-hospital cardiac arrest survivors less than half of the patients was diagnosed with acute coronary syndrome. ACS was associated with a better prognosis even after adjustment for prognostic factors. Successful PCI was likewise an independent prognostic factor, however this may be due to selection bias and a direct support of acute angiography in all OHCA-survivors should await the results of randomised clinical trials. Acknowledgement/Funding Trygfonden

scholarly journals Heart Rate After Resuscitation From Out-of-Hospital Cardiac Arrest due to Acute Coronary Syndrome Is an Independent Predictor of Clinical Outcome

2020 ◽  
Vol 84 (4) ◽  
pp. 569-576 ◽  
Author(s):  
Shingo Matsumoto ◽  
Rine Nakanishi ◽  
Ippei Watanabe ◽  
Hiroto Aikawa ◽  
Ryota Noike ◽  
...  
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Clinical Outcome ◽  
Independent Predictor ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

scholarly journals Decision tree model for predicting in‐hospital cardiac arrest among patients admitted with acute coronary syndrome

2019 ◽  
Vol 42 (11) ◽  
pp. 1087-1093 ◽  
Author(s):  
Hong Li ◽  
Ting Ting Wu ◽  
Dong Liang Yang ◽  
Yang Song Guo ◽  
Pei Chang Liu ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Decision Tree ◽  
Decision Tree Model ◽  
Tree Model ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

scholarly journals KOUNIS SYNDROME - ALLERGIC MYOCARDIAL INFARCTION. A CASE REPORT

2019 ◽  
Vol 72 (1) ◽  
pp. 137-141
Author(s):  
Olga Wajtryt ◽  
Tadeusz M Zielonka ◽  
Aleksandra Kaszyńska ◽  
Andrzej Falkowski ◽  
Katarzyna Życińska
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Allergic Reaction ◽  
Anaphylactic Shock ◽  
Coronary Artery Spasm ◽  
Kounis Syndrome ◽  
Permanent Damage ◽  
Coronary Syndrome

Kounis syndrome or allergic myocardial infarction is an acute coronary syndrome in the course of an allergic reaction. In allergic patients in response to a specific condition - nourishment, inhalation, environmental substances, drug or insect bite there is an allergic reaction involving many different cells and mediators that can cause coronary artery spasm or initiate the process of rupture and activation of atherosclerotic plaque resulting in acute coronary syndrome. The paper describes a case of a young man with allergy to pollen and confirmed sensitization to nuts, who developed a full-blown anaphylactic shock after eating the nut mix and experienced a rapidly passing acute coronary syndrome with troponin up to 4.7 μg/L. An increased concentration of tryptase (15 μg/L), total IgE (> 3,000 IU/mL) and specific anti-nut IgE (55.1 kUA/L) were found. Based on the course of the disease and the results of allergic and cardiac tests, allergic type 1 myocardial infarction, i.e. caused by coronary artery spasm, was diagnosed. During the hospitalization, the patient’s condition improved quickly and after a few days he left the hospital without the signs of permanent damage to the heart muscle.

Abstract 2506: Coronary Spasm Occurs in Coronary Artery with Diffuse Intima Thickeing without Lipd and/or Calcification:Evaluation with Intravascular Optical Coherence Tomography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yoshinobu Morikawa ◽  
Shiro Uemura ◽  
Ken-ichi Ishigami ◽  
Tsunenari Soeda ◽  
Satoshi Okayama ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Thrombus Formation ◽  
Coronary Spasm ◽  
Morphological Characteristics ◽  
Provocation Test ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
Intravascular Optical Coherence Tomography

Coronary spasm (CS) plays an important role in the pathogenesis of many kinds of ischemic heart disease. However, morphological characteristics of coronary artery of CS remain unknown. We evaluated 37 patients with coronary spastic angina (CSA) who underwent diagnostic acetylcholine (ACh) provocation test, and 2 acute coronary syndrome patients suspected to have severe CS. The intravascular optical coherence tomography (OCT) was performed after complete dilatation of coronary artery in all patients and additionally performed during ACh-induced CS in 4 patients. Based on the ACh provocation test, 23 patients who developed CS and ischemic ECG changes were diagnosed as coronary spastic angina (CSA), and other 14 patients without CS were referred as CS-negative patients. CS-negative patients were further divided into 2 sub-groups according to the lipid and/or calcification content in coronary arterial wall by OCT findings. Intravascular OCT revealed most coronary segments with ACh-induced CS had homogenous intima thickening, and quantitative OCT analysis showed that CS-positive segments had significantly larger intima area compared with CS-negative segments without lipid and/or calcification (2.73±0.07 vs. 1.36±0.06 mm 2 , P<0.001). By contrast, CS-positive segments had significantly smaller intima area compared with CS-negative segments with lipid and/or calcification (2.73±0.07 vs. 4.51±0.17 mm 2 , P<0.001). During ACh-induced CS, lumen and total vascular area significantly decreased, whereas intima area did not change in comparison with complete vasodilatation. Furthermore, luminal surface of intimal layer formed markedly wavy configuration during CS. In CSA cases with acute coronary syndrome, we observed additional findings of intima injury as erosion and thrombus formation at spasm site. Coronary spasm occurs in coronary artery with diffuse intima thickening without lipid and/or calcification content but not in artery either without intima thickening or with lipid and/or calcification, and coronary spasm sometimes induces intimal injury by itself which may cause acute coronary event.

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