Optical Coherence Tomography and PCI in a Patient With Methamphetamine-Associated Spontaneous Coronary Artery Dissection
Bibliographic record
Abstract
A 44-year-old man with a history of significant methamphetamine abuse presented following witnessed out-of-hospital cardiac arrest. Immediate bystander cardiopulmonary resuscitation was initiated, with return of spontaneous circulation. The patient was intubated and noted to have increasing requirements for hemodynamic support. An electrocardiogram demonstrated anterior Q-waves with minor (<1 mm) ST-segment elevation in leads V1-V3, with corresponding ST-segment depression in leads II and III, and arteriovenous fistula, and echocardiography demonstrated severely reduced left ventricular systolic function. Coronary angiography demonstrated a diffuse linear hazy lesion in the mid left anterior descending (LAD) artery, suspicious for spontaneous coronary artery dissection (SCAD) (Fig. 1A). Given the thrombolysis in myocardial infarction (TIMI) 3 flow, this was initially managed conservatively. The patient was extubated but continued to have angina 1 week later. The patient also described having used methamphetamine earlier in the same day of his cardiac arrest. Computed tomography angiography of the brain and renal arteries did not show evidence of fibromuscular dysplasia. Re-look coronary angiography and optical coherence tomography (OCT) revealed multiple false lumens, intimal tears, and significant stenosis of the mid LAD artery, compressed by intraluminal hematoma (Fig. 2A ; Fig. 1B; Video 1 , view video online). Given the symptomatic state and angiographic worsening of the lesion post OCT, percutaneous coronary intervention was performed to the mid LAD artery, under OCT guidance (Fig. 2B).Figure 2(A) Linear haziness in mid left anterior descending artery (white arrow) suspicious for spontaneous coronary artery dissection. (B) Post–percutaneous coronary intervention mid left anterior descending artery.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Fibromuscular dysplasia is well described in many patients with SCAD. However, amphetamine-associated SCAD is rare, with a limited number of cases reported.1Navid H. Soleimani H. Hosseini K. Wild at heart: 34-year-old male with new onset dyspnea, heart failure and history of amphetamine use; a case report.Egypt Heart J. 2019; 71: 20Crossref PubMed Scopus (2) Google Scholar,2Saw J. Aymong E. Sedlak T. et al.Spontaneous coronary artery dissection association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes.Circ Cardiovasc Interv. 2014; 7: 645-655Crossref PubMed Scopus (338) Google Scholar There are no reported OCT images in the literature of amphetamine-associated SCAD, and our case is the first OCT demonstration of this rare etiology of SCAD. However, the differential diagnosis also includes either a re-canalized vessel post prior infarction, a woven coronary artery anomaly, or plaque rupture with emptied cavity. These cannot be excluded with certainty, especially in the context of the presence of anterior Q-waves and underlying severe left ventricular systolic dysfunction. Our case highlights the role of OCT imaging in helping identify the etiology of SCAD, ensuring proper wire positioning in the true lumen, and identifying entrance and exit intimal tears to guide the percutaneous coronary intervention strategy.Novel Teaching Point•Careful use of optical coherence tomography can help clarify etiology and guide management decisions in patients with suspected spontaneous coronary artery dissection. •Careful use of optical coherence tomography can help clarify etiology and guide management decisions in patients with suspected spontaneous coronary artery dissection. The authors have no funding sources to declare.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".