title: [Clinical implications of intracoronary findings beyond coronary angiograms in patients with sudden death and high probability of coronary artery disease].
abstract: Of 12 patients with sudden death and a high probability of coronary artery disease who underwent cardiac catheterization, 4 (25%) showed coronary arteries without significant obstructive lesions or angiographic signs of instability. The study protocol included an invasive study of coronary vasoreactivity and an intracoronary imaging study with intravascular ultrasound. The coronary reactivity study showed coronary vasospasm in 1 patient. Intravascular ultrasound showed active coronary plaques with images suggesting intraluminal thrombus in all patients. The diagnosis reached was sudden death secondary to ventricular arrhythmias in the context of acute coronary syndrome; the use of an implantable cardioverter-defibrillator was therefore not indicated. In conclusion, in patients with sudden death with a high probability of coronary artery disease but with coronary arteries lacking significant lesions, intracoronary imaging (eg, by intravascular ultrasound) may be essential to establish a diagnosis and appropriate treatment, even in patients with induced coronary vasospasm.
authors.affiliation: Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España. recalde@secardiologia.es
authors.forename: Angel
authors.initials: A
authors.lastname: Sánchez-Recalde
authors.forename: José L
authors.initials: JL
authors.lastname: Merino
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.forename: Santiago
authors.initials: S
authors.lastname: Jiménez-Valero
authors.forename: Guillermo
authors.initials: G
authors.lastname: Galeote
authors.forename: Luis
authors.initials: L
authors.lastname: Calvo
authors.forename: Esteban
authors.initials: E
authors.lastname: López de Sá
authors.forename: José L
authors.initials: JL
authors.lastname: López-Sendón
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional