Optical Coherence Tomography for the Diagnosis of Exercise-Related Acute Cardiovascular Events and Inconclusive Coronary Angiography

• Published in: Journal of interventional cardiology Vol. 2020; no. 2020; pp. 1 - 10
• Main Authors: Peral-Disdier, Vicente, Alameda, María del Mar, Pascual, Marcos, Gómez-Lara, Josep, Maristany, Jaume, Mas-Lladó, Caterina, Gómez-Jaume, Alfredo
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 2020; Hindawi; John Wiley & Sons, Inc; Hindawi Limited; Wiley
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - etiology; Acute coronary syndromes; Aerobics; Angiography; Blood clots; Calcification; Cardiovascular disease; Cardiovascular diseases; Coronary Angiography - methods; Coronary artery; Coronary heart disease; Coronary Stenosis - complications; Coronary Stenosis - diagnosis; Coronary vessels; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - pathology; Development and progression; Diagnosis; Dissection; Ejection fraction; Etiology; Exercise; Female; Heart attacks; Humans; Hypertension; Incidence; Male; Medical imaging; Medical research; Medicine, Experimental; Middle Aged; Patients; Physical activity; Physical Exertion - physiology; Physical fitness; Physical training; Plaque, Atherosclerotic - complications; Plaque, Atherosclerotic - diagnosis; Prospective Studies; Rupture; Statistical analysis; Stenosis; Stents; Tomography; Tomography, Optical Coherence - methods
• ISSN: 0896-4327; 1540-8183
• DOI: 10.1155/2020/8263923

Objectives. The aim of this study is to assess the utility of optical coherence tomography (OCT) in patients with exercise-related acute coronary syndrome (ACS) presenting with inconclusive angiographic findings. Background. Regular physical activity reduces the incidence of cardiovascular events. Nevertheless, the risk of ACS or sudden cardiac death (SCD) increases during sport. In adults older than 35 years, exercise-related ACS or SCD is associated with plaque rupture, but not infrequently patients present ambiguous angiographic findings. Methods. Between September 2015 and January 2020, patients admitted for ACS or SCD triggered by physical exertion and with coronary stenosis ≤50% were included in this prospective observational study. OCT was performed on the artery deemed to be responsible of the event. Results. Ten patients were enrolled, predominantly men (80%) of middle age (51 years old, IQR 41–63) with low cardiovascular risk burden. Cycling was the most frequent (50%) exercise-related trigger, 8 patients were regular sport practitioners, and 7 had the clinical event during strenuous exertion. Five patients presented with non-ST-elevation ACS, two with ST-elevation ACS, and three with SCD. Angiographic analysis showed nonsignificant stenosis in all patients (42% stenosis, IQR 36–46). OCT identified the etiology of the event in 9 patients (4 plaque erosion, 3 plaque rupture, 1 eruptive calcific nodule, and 1 coronary dissection). Treatment was adjusted according to OCT findings. Conclusions. OCT is a valuable technique to identify the etiology of exercise-related ACS or SCD in patients with nonobstructive coronary arteries and, as a result, may lead to a more specific treatment.