None listed
Conditions
Brief summary
A national, multi-centre observational study is proposed to evaluate the prevalence of coronary artery vasospasm in patients with unexplained cardiac arrest. Patients over the age of 18 years who have suffered an unexplained cardiac arrest (n=60) will undergo invasive functional angiography with acetylcholine challenge to assess for coronary artery vasospasm as a potential cause for their cardiac arrest. A small control group of patients with explained cardiac arrest (n=10) will also undergo functional coronary angiography as a comparator. The primary end point is the percentage of patients with a diagnosis of coronary artery vasospasm as defined by the Coronary Vasomotor Disorders International Study Group (COVADIS) criteria. The secondary end point is the association of risk factors leading to a diagnosis of coronary artery vasospasm. We expect this study will show a significant percentage of patients with a diagnosis of coronary artery vasospasm as a potential cause for their cardiac arrest, which will allow for targeted treatment in the prevention of further cardiac arrest, leading to improved patient outcomes.
Interventions
Patients with unexplained cardiac arrest will undergo an invasive functional angiography 4-6 weeks following their cardiac arrest, with administration of intracoronary acetylcholine boluses to assess for coronary artery vasospasm. The left coronary artery will be assessed first, by injecting escalating doses of acetylcholine from 50mcg, 100mcg, 150mcg and 200mcg. If a diagnosis of coronary vasospasm is achieved prior to reaching the maximum 200mcg dose then no further boluses will be administere
Patients with unexplained cardiac arrest will undergo an invasive functional angiography 4-6 weeks following their cardiac arrest, with administration of intracoronary acetylcholine boluses to assess for coronary artery vasospasm. The left coronary artery will be assessed first, by injecting escalating doses of acetylcholine from 50mcg, 100mcg, 150mcg and 200mcg. If a diagnosis of coronary vasospasm is achieved prior to reaching the maximum 200mcg dose then no further boluses will be administered. If no diagnosis is achieved following assessment of the left coronary artery then the right coronary artery will be assessed with escalating boluses of acetylcholine from 20mcg, 40mcg, 60mcg and 80mcg. If a diagnosis of coronary vasospasm is achieved prior to reaching the maximum 80mcg dose then no further boluses will be administered. This will be performed by the cardiologists participating as study investigators in this study. The procedure will take approximately 1 hour to perform. Results from this investigation and adherence will be obtained from hospital medical records. Patients not wishing to participate in this study may also be recommended to undergo invasive functional angiography however this would be up to the discretion of their treating clinician and is not part of standard work up.
Sponsors
Alfred Health
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients aged 18 years with unexplained cardiac arrest.
Exclusion criteria
Patients with an identifiable or clinically suspected cause for cardiac arrest according to clinicians caring for the patient inclusive of but not limited to: - Acute coronary syndrome due to plaque rupture or severe disease - Suspected cardiac arrhythmias from LQTS, Brugada or other arrhythmogenic cause - Non-cardiac causes e.g. acute renal failure, pulmonary emboli, sepsis - Acute myocardial dysfunction or inflammation e.g. myocarditis, infection (COVID) Contraindications to receiving acetylcholine.
Outcome results
None listed