Meune Christophe, Joly Luc-Marie, Chiche Jean-Daniel, Charpentier Julien, Leenhardt Antoine, Rozenberg Alain, Carli Pierre, Sauval Patrick, Weber Simon, Cracan Aurel, Spaulding Christian
Cardiology Department, Cochin Hospital, René Descartes University, 75014 Paris, France.
Resuscitation. 2003 Aug;58(2):145-52. doi: 10.1016/s0300-9572(03)00149-7.
The clinical features of coronary artery spasm as a cause of cardiac arrest were determined in a prospective study on out-of-hospital cardiac arrest (OHCA).
Coronary angiography was performed at admission in 300 consecutive patients with no obvious non-cardiac cause of OHCA. In survivors with no or minimal coronary artery stenosis, a second angiography with provocation test and electrophysiological testing were performed at 1 month.
Spasm was demonstrated in ten patients. Diagnosis was based upon (1) spontaneous spasm on the admission angiogram (3 patients), (2) transient significative ST-segment elevation at follow-up in patients with no or non-significant coronary artery lesions (4 patients) and (3) spasm during the 1 month provocation test (3 patients). Six patients survived at 1 month; spasm occurred during a new provocation test in five despite treatment with high dosage calcium channel blockers leading to coronary stenting in two, an internal cardiovertor defibrillator in one, and increased drug therapy with prolonged hospitalization in the remainder. At a mean follow-up of 55+/-27 months, no recurrent cardiac arrest occurred.
Systematic coronary angiograms and provocation tests in survivors of OHCA allow prompt diagnosis of coronary artery spasm. Residual spasm despite treatment with calcium channel blockers is frequent. Therapy should therefore be guided by repetitive provocation tests, and seems to avoid recurrence of cardiac arrest.
在一项关于院外心脏骤停（OHCA）的前瞻性研究中，确定作为心脏骤停原因的冠状动脉痉挛的临床特征。
对300例无明显非心脏原因导致OHCA的连续患者入院时进行冠状动脉造影。对于冠状动脉无狭窄或狭窄程度轻微的幸存者，在1个月时进行第二次带有激发试验的血管造影和电生理测试。
10例患者显示有痉挛。诊断依据为：（1）入院血管造影时的自发性痉挛（3例患者）；（2）冠状动脉无病变或病变不明显的患者在随访时出现短暂性显著ST段抬高（4例患者）；（3）1个月激发试验期间出现痉挛（3例患者）。6例患者在1个月时存活；尽管使用高剂量钙通道阻滞剂进行治疗，但仍有5例在新的激发试验期间出现痉挛，其中2例导致冠状动脉支架置入，1例植入体内心脏复律除颤器，其余患者增加药物治疗并延长住院时间。平均随访55±27个月时，未发生复发性心脏骤停。
对OHCA幸存者进行系统性冠状动脉造影和激发试验可迅速诊断冠状动脉痉挛。尽管使用钙通道阻滞剂治疗，但残留痉挛仍很常见。因此，治疗应以重复性激发试验为指导，且似乎可避免心脏骤停复发。
