scholarly journals Psychological and clinical characteristics of patients with spontaneous coronary artery dissection: A case-control study

2021 ◽  
Vol 323 ◽  
pp. 1-6
Author(s):  
Veerle R. Smaardijk ◽  
Paula M.C. Mommersteeg ◽  
Willem J. Kop ◽  
Dario Pellegrini ◽  
Robert-Jan van Geuns ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Clinical Characteristics ◽  
Case Control Study ◽  
Case Control ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Control Study

Percutaneous coronary intervention in spontaneous coronary artery dissection: a case-control study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Kotecha ◽  
A.D.P.E Premawardhana ◽  
M Garcia-Guimaraes ◽  
D Pellegrini ◽  
A.D Wood ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Case Control Study ◽  
Case Control ◽  
Artery Dissection ◽  
Funding Source ◽  
Complication Rates ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Control Study ◽  
Reduced Flow

Abstract Background Spontaneous Coronary Artery Dissection (SCAD) is an important cause of acute coronary syndrome particularly in young-middle aged women. Revascularisation is challenging due to an underlying disrupted and friable coronary vessel wall leading to widely reported worse outcomes than for atherosclerotic coronary disease. Therefore, a conservative approach where possible is favoured however in some cases haemodynamic instability, ongoing ischaemia and reduced distal flow mandates consideration of revascularisation. Purpose To compare SCAD survivors managed with PCI or conservatively in terms of presentation characteristics, complications and long-term outcomes. Methodology and results 226 angiographically confirmed SCAD survivors (95% female,47±9.7yrs) who underwent PCI were compared in a case control study with two hundred and twenty-five angiographically confirmed SCAD survivors (92% female, 49±9.9yrs) who were conservatively managed. Patients were recruited from UK, Spanish and Dutch SCAD registries and both groups were well matched in terms of baseline demographics. Those treated with PCI were more likely to present with proximal SCAD (30.8% vs 7.6% P<0.01) and ST elevation myocardial infarction (STEMI) or cardiac arrest with reduced flow (32.3% vs 6.3% P<0.01). Intervention was performed with stents in 72.4%, plain old balloon angioplasty in 21.1% and wiring in 6.4% of cases and more often for multi-segment disease (40.8% vs 26.3% P<0.01). In cases with initial reduced flow undergoing PCI an improvement in flow was seen in 83%. Analysis of UK PCI cases (n=144) reveal complications in 56 (38.8%). However, when assessed for significance defined by a reduction in flow in a proximal/mid vessel, stent extension into left main stem, iatrogenic dissection requiring PCI and CABG as a consequence of PCI only 13 cases (9%) met criteria. Iatrogenic dissection accounts for the majority (76.9%). SCAD lesion length was associated with presence of complications (P=0.025). There was a non-significant trend towards major adverse cardiovascular events (MACE) occurring more frequently in those undergoing PCI (18% vs 11% P=0.067) driven by revascularisation (5% vs 1% P=0.036). Median follow up was 2.7 years. Conclusions PCI in SCAD is often performed in higher risk patients; in those presenting with reduced flow, the majority demonstrate improvement. Importantly whilst overall complication rates were similar to those widely reported, clinically significant complications were low. Multivariate modelling will reveal factors associated with complications to aid future decision making in this challenging patient group. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation

scholarly journals Clinical characteristics and long-term prognosis of spontaneous coronary artery dissection: A single-center Chinese experience

2019 ◽  
Vol 35 (1) ◽  
Author(s):  
Xintian Liu ◽  
Chengyi Xu ◽  
Chengwei Liu ◽  
Xi Su
Keyword(s):  
Coronary Artery ◽  
Clinical Characteristics ◽  
Conservative Therapy ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Single Center ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Long Term Prognosis

Background and Objective: Spontaneous coronary artery dissection (SCD) remains a rare and important cause of coronary artery disease (CAD). The purpose of this study was to describe the clinical and angiographic features in SCD and to evaluate the treatment and long-term prognosis of this condition in China. Methods: This retrospective cohort study included 118 Chinese patients with SCD confirmed by coronary angiography. Clinical and angiographic features, treatment modalities and outcomes of SCD were estimated. Results: The overall prevalence of SCD was 0.15%. Age was 57 ± 10 years; 86% patients were men; 75% presented with acute coronary syndrome (ACS); 72% had concomitant atherosclerotic CAD. SCD often affected right coronary artery (RCA) and caused a short dissection (< 20mm). A conservative therapy was used in 28% of patients and revascularization in 72% (percutaneous coronary intervention [PCI] 57%; coronary artery bypass grafting [CABG] 15%). Only one patient died during hospitalization due to multiple organ failure after CABG. During a median follow-up of 43 months (range, 1 - 158 months), 32 patients had a new-onset ACS, 9 received revascularization (7 PCI and 2 CABG), and 8 died. The Kaplan-Meier estimated 12-year rates of freedom from cardiac death and ACS were both higher in revascularization versus conservative therapy (78% versus 57%; P = 0.023; 48% versus 25%, P = 0.014). No significant difference was found in freedom from revascularization between the two therapies. Conclusions: In China, SCD was usually associated with atherosclerosis and predominantly affected male population. SCD often affected RCA and caused a short dissection. In-hospital mortality rate was low regardless of therapeutic strategy. However, a significantly better long-term prognosis was observed in the revascularization compared with conservative therapy. How to cite this:Liu X, Xu C, Liu C, Su X. Clinical characteristics and long-term prognosis of spontaneous coronary artery dissection: A single-center Chinese experience. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.321 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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