P1318Optical coherence tomography to detect acute coronary syndrome in survivors of out-of-hospital cardiac arrest without ST-segment elevation on the ECG

Abstract

Introduction: 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). Methods: In our center, all OHCA patients without obvious extracardiac cause undergo systematic emergency coronary angiography irrespective of ECG findings. Patients with ST-segment elevation on the ECG and impaired coronary flow or patients with acute coronary occlusion were treated by percutaneous coronary intervention (PCI) without OCT-imaging. In patients with mild coronary atheroma, 3-vessel OCT was performed followed by PCI if plaque rupture or acute thrombosis were detected. Patients with CABG or chronic total coronary occlusion (CTO) were excluded. Results: Between February and August 2016, 50 consecutive patients were included. Fourteen patients had ST-segment elevation on the initial ECG. Among the 36 patients without ST-segment elevation after ROSC, 21 had angiographically normal coronary arteries, 2 had CTO, 1 had previous CABG, 2 had acute coronary occlusion and 10 had mild coronary atheroma. OCT revealed coronary plaque rupture and/or thrombus in 7 of the patients with mild coronary atheroma (70%). They subsequently underwent immediate angioplasty of the identified lesion. No complications occurred due to intravascular imaging. Conclusion: Plaque rupture or acute coronary thrombosis was observed in 25% of our all-comers population of consecutive OHCA patients without ST-segment elevation on the ECG, and in up to 70% of those with mild coronary atheroma. Thus, one out of four OHCA patients without ST-segment elevation on the ECG after ROSC had an acute coronary syndrome, which would not have been diagnosed without systematic coronary angiography and intracoronary imaging. (Figure Presented).