Brunel Maxence, Harbaoui Brahim, Bitker Laurent, Chambonnet Carole, Aubry Matthieu, Boussel Loïc, Besnard Cyril, Richard Jean-Christophe, Lantelme Pierre, Courand Pierre-Yves
Fédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, Lyon, F-69004, France.
Université de Lyon, CREATIS; CNRS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1, Lyon, France.
Ann Intensive Care. 2025 Apr 7;15(1):50. doi: 10.1186/s13613-025-01423-5.
Emergency coronary angiogram after a cardiac arrest without ST-segment elevation myocardial infarction (STEMI) is still a matter of debate. To better select patients who may benefit from this procedure, we tested a visual coronary artery calcification (VCAC) score available in chest CT to predict significant coronary artery stenosis and/or culprit lesion or ad hoc or delayed percutaneous coronary intervention (PCI).
A total of 113 patients with cardiac arrest and without STEMI who had a coronary angiogram and chest CT (January 2013 to March 2023, Croix-Rousse Hospital, Lyon, France) were retrospectively included. VCAC was scored from 0 (no calcification) to 3 (diffuse calcification) for each 4 four main arteries (left main, left anterior descending, circumflex, and right coronary artery). At baseline the median [interquartile range] age was 65.8 years [53.4-75.7], 61.9% were male, and 59.3% presented with ventricular fibrillation. Coronary angiogram identified at least one significant coronary artery stenosis in 32.7%, and ad hoc and delayed PCI were performed in 12.4% and 6.2% of the patients, respectively. VCAC score was an excellent predictor of significant coronary artery stenosis with an area under the ROC curve (AUC) of 0.95 (95%CI [0.90-1.00]) and the optimal threshold was ≥ 4 (specificity 94.7%, sensitivity 91.9%). For the detection of culprit coronary artery stenosis, the AUC was at 0.90 (95%CI [0.85-0.96]) and the optimal threshold was ≥ 5 (specificity 83.5%, sensitivity 87.5%). The AUC was 0.886 [0.823-0.948] (specificity 81.8%, sensitivity 85.7%) for ad hoc PCI and 0.921 [0.872-0.972] (specificity 85.3%, sensitivity 88.9%) for both delayed and ad hoc PCI with a same optimal threshold of VCAC ≥ 5. A VCAC score ≥ 4 had a sensitivity at 100% to predict a significant or culprit coronary artery stenosis and ad hoc or delayed PCI.
The present study found that a non-dedicated CT thorax may be useful to measure VCAC and if this is scored ≥ 4 it allows physicians to better select patients resuscitated from cardiac arrest with non-STEMI and without history of coronary artery disease who may benefit from an emergency coronary angiogram to detect a significant or culprit coronary artery stenosis and had PCI if appropriate.
心脏骤停后无ST段抬高型心肌梗死（STEMI）的急诊冠状动脉造影仍存在争议。为了更好地选择可能从该手术中获益的患者，我们测试了胸部CT中可用的视觉冠状动脉钙化（VCAC）评分，以预测严重冠状动脉狭窄和/或罪犯病变，或临时或延迟经皮冠状动脉介入治疗（PCI）。
回顾性纳入了113例心脏骤停且无STEMI的患者，这些患者均接受了冠状动脉造影和胸部CT检查（2013年1月至2023年3月，法国里昂克鲁瓦罗西医院）。对每4条主要动脉（左主干、左前降支、回旋支和右冠状动脉）的VCAC从0分（无钙化）到3分（弥漫性钙化）进行评分。基线时，年龄中位数[四分位间距]为65.8岁[53.4 - 75.7]，61.9%为男性，59.3%表现为心室颤动。冠状动脉造影显示32.7%的患者至少有一处严重冠状动脉狭窄，分别有12.4%和6.2%的患者接受了临时和延迟PCI。VCAC评分是严重冠状动脉狭窄的优秀预测指标，ROC曲线下面积（AUC）为0.95（95%CI[0.90 - 1.00]），最佳阈值为≥4（特异性94.7%，敏感性91.9%）。对于罪犯冠状动脉狭窄的检测，AUC为0.90（95%CI[0.85 - 0.96]），最佳阈值为≥5（特异性83.5%，敏感性87.5%）。临时PCI的AUC为0.886[0.823 - 0.948]（特异性81.8%，敏感性85.7%），延迟和临时PCI的AUC为0.921[0.872 - 0.972]（特异性85.3%，敏感性88.9%），VCAC的最佳阈值均为≥5。VCAC评分≥4对预测严重或罪犯冠状动脉狭窄以及临时或延迟PCI的敏感性为100%。
本研究发现，非专用胸部CT可能有助于测量VCAC，如果评分≥4，可使医生更好地选择从心脏骤停中复苏且无STEMI且无冠状动脉疾病史的患者，这些患者可能从急诊冠状动脉造影中获益，以检测严重或罪犯冠状动脉狭窄，并在适当情况下进行PCI。
