Resuscitated sudden cardiac arrest related to intraplaque haemorrhage and coronary artery spasm.

Abstract

A 72-year-old man with a history of chronic kidney disease, dyslipidaemia, and hypertension felt chest tightness after walking uphill and sat down to rest. Shortly thereafter, he suddenly collapsed, and cardiopulmonary resuscitation was started by a nearby family member. The initial electrocardiogram waveform was ventricular fibrillation, which was restored to sinus rhythm with an automated external defibrillator. He was transported to our hospital. No significant electrocardiographic changes, but positive serum troponin was observed on arrival. Emergency coronary angiography was performed, revealing a moderate stenosis in the proximal left anterior descending coronary artery (Panel A) which was functionally significant (Panel B). Optical coherence tomography showed a large eccentric plaque with a confined low-intensity plaque with strong signal attenuation (Panel C) and some areas of low intensity and low attenuation (Panel D), highly suggestive of intraplaque haemorrhage (IPH) (see Supplementary data online, Video S1).1 A stent implantation was subsequently performed (Panel E). On the ninth day of hospitalization, an acetylcholine provocation test was performed for the right coronary artery and severe diffuse coronary spasm was induced (Panels F and G) accompanied by chest tightness and ST elevation on electrocardiogram, leading to a diagnosis of coronary spastic angina.