scholarly journals AB0498 CHARACTERISTICS AND OUTCOME OF CORONARY ARTERY LESIONS DUE TO POLYARTERITIS NODOSA: ANALYSIS OF A SINGLE CENTER COHORT IN CHINA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1547.2-1547
Author(s):  
C. Lai ◽  
L. Zhao ◽  
J. Zhou ◽  
D. Xu ◽  
X. Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Polyarteritis Nodosa ◽  
Artery Dissection ◽  
Renal Infarction ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Lesions ◽  
Coronary Artery Dissection ◽  
Significant Difference

Background:Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that mainly affects medium-sized muscular arteries. The coronary artery could be affected. Some severe cases can lead to spontaneous coronary artery dissection (SCAD) and about 0.02% will die abruptly. Early diagnosis will improve prognosis, but relative studies are all case reports so far.Objectives:To investigate the clinical characteristics, risk factors and outcome of patients with polyarteritis nodosa (PAN) complicated with coronary artery lesions in China.Methods:Data of 158 patients with PAN who were admitted to Peking Union Medical College Hospital from September 1986 to September 2019 were retrospective collected. Data were analyzed and compared according to with and without coronary artery lesions due to PAN.Results:17 (10.8%) patients with PAN had the coronary artery lesions due to PAN. The age at coronary artery lesion was 36.9±10.3 years. 12 (70.6%) patients were male. There are not statistical differences between two groups in common risk factors of coronary arterial atherosclerosis including smoking, hypertension, diabetes mellitus and hyperlipidemia. Most of them are multi-vessel lesions (8 cases are triple-vessel lesions and 3 cases are bi-vessel lesions). Type of coronary artery affected is shown mainly in stenosis (13 cases). Myocardial infarction are shown in 8 cases (47.1%). Compared to patients without coronary artery lesions, patients with coronary artery lesions had less nervous system involvement (17.6% vs.46.8%) and elevated number of leukocyte (17.6% vs.56%). Besides, patients with coronary artery affected exhibit more cranial and carotid artery involvement(29.4% vs. 5.0%), renal artery involvement (41.2% vs.17.0%), coeliac artery involvement (58.8% vs.27.0%), new onset hypertension (47.1% vs.14.5%), renal infarction (27.3% vs.5.4%, ) and higher proportion of 2009 Five-factor score (FFS)≥2 (62.5% vs.15.6%). All patients with coronary artery lesions received at least moderate dose of prednisone and CTX except one refused medication. 3 cases underwent interventional therapy. Stent placement was performed on 2 of them, and in-stent restenosis was appeared in a patient one year later. 2 cases died,one for vascular rupture after coronary aneurysmsutrue plus coronary artery bypass grafting, another for myocardial infarction after stopping immunosuppressant therapy himself.Survival analysis showed patients with digital g angrene had poor prognosis though no significant difference(p=0.055).Conclusion:PAN with coronary artery lessions are not uncommon. These patients exhibit young age, more proportion of multi-vessel of coronary artery involvement, more combined involvments of other organ arteries and more severe disease.References:[1]Munguti CM, Ndunda PM, Muutu TM. Sudden Death From Spontaneous Coronary Artery Dissection Due to Polyarteritis Nodosa. Cureus, 2017;9 (10), e1737[2]Kritta nawong C, Kumar A, Johnson KW, et al.Conditions and Factors Associated With Spontaneous Coronary Artery Dissection (From a National Population-Based Cohort Study).Am J Cardiol, 2019; 123 (2): 249-253[3]Hwang J, Yang JH, Kim DK, Cha HS.Polyarteritis Nodosa Involving Renal and Coronary Arteries. J Am Coll Cardiol. 2012;59(7):e13Disclosure of Interests: :Chinchih Lai: None declared, Lin Zhao: None declared, Jiaxin Zhou: None declared, Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared

scholarly journals Changing Incidence and Mechanism of Pregnancy‐Associated Myocardial Infarction in the State of California

2021 ◽  
Author(s):  
Sawan Jalnapurkar ◽  
Karen Huaying Xu ◽  
Zhiwei Zhang ◽  
C. Noel Bairey Merz ◽  
Uri Elkayam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Mortality Rate ◽  
The State ◽  
Infant Mortality Rate ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Takotsubo Syndrome ◽  
Coronary Artery Dissection

Background The objective of this study was to evaluate the temporal trends in pregnancy‐associated myocardial infarction (PAMI) in the State of California and explore potential risk factors and mechanisms. Methods and Results The California State Inpatient Database was analyzed from 2003 to 2011 for patients with International Classification of Diseases, Ninth Revision ( ICD‐9 ) codes for acute myocardial infarction and pregnancy or postpartum admissions; risk factors were analyzed and compared with pregnant patients without myocardial infarction. A total of 341 patients were identified with PAMI from a total of 5 266 380 pregnancies (incidence of 6.5 per 100 000 pregnancies). Inpatient maternal mortality rate was 7%, and infant mortality rate was 3.5% among patients with PAMI. There was a nonsignificant trend toward an increase in PAMI incidence from 2003 to 2011, possibly attributable to higher incidence of spontaneous coronary artery dissection, vasospasm, and Takotsubo syndrome. PAMI, when compared with pregnant patients without myocardial infarction, was significant for older age (aged >30 years in 72% versus 37%, P <0.0005), higher preponderance of Black race (12% versus 6%, P <0.00005), lower socioeconomic status (median household income in lowest quartile 26% versus 20%, P =0.04), higher prevalence of hypertension (26% versus 7%, P <0.0005), diabetes (7% versus 1%, P <0.0005), anemia (31% versus 7%, P <0.0001), amphetamine use (1% versus 0%, P <0.00005), cocaine use (2% versus 0.2%, P <0.0001), and smoking (6% versus 1%, P =0.0001). Conclusions There has been a trend toward an increase in PAMI incidence in California over the past decade, with an increasing trend in spontaneous coronary artery dissection, vasospasm, and Takotsubo syndrome as mechanisms. These findings warrant further investigation.

scholarly journals Spontaneous coronary artery dissection – contemporary management and outcome of a national cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Wilander ◽  
E Swahn ◽  
N Johnston ◽  
L Jonasson ◽  
C Pagonis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Statin Treatment ◽  
Artery Dissection ◽  
Funding Source ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Significant Difference ◽  
National Cohort

Abstract Background Spontaneous coronary artery dissection (SCAD) is proposed to cause 1–4% of all acute myocardial infarctions (AMI). The aim of this study was to conduct a first description of Swedish SCAD patients regarding the prevalence of risk factors, treatment and prognosis. Method All patients with AMI registered in the Swedish Coronary Angiography and Angioplasty Register (SCAAR) December 2015 until December 2017 were included. The index angiographies of the SCAD patients were reevaluated by an independent angiographer at each center. Patients with non-SCAD AMI (n=31670) were used for comparison. Results SCAD was identified in 137 patients with AMI (100 women, 37 men). The SCAD population was younger than the non-SCAD population 53.9 (51.7–56.1) vs 68.5 (68.3–68.6) years, more often women (73.0 vs 30.7%) and presented with less risk factors: diabetes 2.9 vs 20.8%; hypertension 27.0 vs 57.6%; smoking 41.2 vs 58.1%; statin therapy 12.4 vs 36.9% and previous AMI 7.3 vs 19.6% (p&lt;0.001 for all comparisons). SCAD patients less frequently underwent percutaneous coronary intervention (PCI) 43.1 vs 70.8% (p&lt;0.001) and received less statin treatment, 78.9 vs 91.5% (p&lt;0.001). There was no significant difference regarding treatment with aspirin or double antiplatelet therapy at discharge: 93 vs 89.7% (p=0.45) and 86.7 vs 84.2%, respectively (p=0,43). There was no significant difference in one-year mortality 6.6 vs 8.2% (p=0.57). Conclusions With a current prevalence of 0.43% of all Swedish AMIs, data supports SCAD being an underdiagnosed condition with a prognosis resembling that of non-SCAD AMI. Furthermore, SCAD patients are younger and harbor less cardiovascular risk factors. While significant differences in management are present, current therapeutic strategies of the two groups are similar, indicating overtreatment of SCAD. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Swedish Heart-Lung foundation, ALF funding

scholarly journals BRIEF SUMMARY OF PATHOGENESIS, DIAGNOSIS AND MANAGEMENT OF SPONTANEOUS CORONARY ARTERY DISSECTION

2020 ◽  
Vol 30 (3) ◽  
pp. 136-140
Author(s):  
Algirdas Rėkus ◽  
Gediminas Jaruševičius
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Disease Risk ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Gold Standard Method ◽  
Coronary Syndrome

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). It was first described 80 years ago. Pathogenetic me­chanisms are most likely to be associated with inti­mas tear or bleeding vasa-vasorum, which resulting in intramural haemorrhage. SCAD typically occurs in young women who do not have coronary heart disease risk factors and who have acute coronary syndrome. Half of all SCAD presents with ST – ele­vation myocardial infarction (STEMI), while the rest with non – ST – elevation myocardial infarction (NSTEMI). The gold standard method for diagnosis is interventional coronary artery angiography. After the acute ischemic onset syndrome, most patients have a stable, benign clinical course, and eventually expe­rience spontaneous vessel wall healing. Therefore, conservative treatment (a watchful strategy) is recom­mended as the initial treatment. For the majority of cases as interventional and surgical treatment in most cases seems to be suboptimal. In this extremely com­plex situation, several novel and attractive coronary interventions have been proposed. The risk factors, pathogenesis theories, diagnosis, management, pro­gnosis of SCAD will be summarized in this review.

scholarly journals Spontaneous Coronary Artery Dissection/Intramural Haematoma in Young Women with ST-Elevation Myocardial Infarction: “It Is Not Always a Plaque Rupture Event”

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
George Kassimis ◽  
Athanasios Manolis ◽  
Jonathan N. Townend
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Young Women ◽  
St Elevation Myocardial Infarction ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
St Elevation ◽  
Conventional Risk Factors

Spontaneous coronary artery dissection (SCAD) is an unusual, but increasingly recognized, cause of ST-elevation myocardial infarction (STEMI), especially among younger patients without conventional risk factors for coronary artery disease (CAD). Although dissection of the coronary intima or media is a hallmark finding, hematoma formation within the vessel wall is often present. It remains unclear whether dissection or hematoma is the primary event, but both may cause luminal stenosis and occlusion. The diagnosis of SCAD is made principally with invasive coronary angiography, although adjunctive intracoronary imaging modalities may increase the diagnostic yield. In STEMI patients, the decision whether to pursue primary percutaneous coronary intervention (PCI) or appropriate conservative medical therapy is based on clinical presentation, the extent of the dissection, the critical anatomy involvement, and the amount of ischaemic myocardium at risk. In this case report, we present two cases of young women with SCAD and STEMI, successfully treated with primary PCI. We briefly illustrate the characteristic aspects of the angiographic presentation and intravascular ultrasound-guided treatment. SCAD should always be considered in young STEMI patients without conventional risk factors for CAD with primary angioplasty to be required in patients with ongoing myocardial ischemia.

Recognition of acute myocardial infarction caused by spontaneous coronary artery dissection of first septal perforator

2021 ◽  
Author(s):  
Scott W Sharkey ◽  
Mesfer Alfadhel ◽  
Christina Thaler ◽  
David Lin ◽  
Meagan Nowariak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Acute Chest Pain ◽  
Vancouver General Hospital ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Septal Perforator

Abstract Aims  Spontaneous coronary artery dissection (SCAD) diagnosis is challenging as angiographic findings are often subtle and differ from coronary atherosclerosis. Herein, we describe characteristics of patients with acute myocardial infarction (MI) caused by first septal perforator (S1) SCAD. Methods and results  Patients were gathered from SCAD registries at Minneapolis Heart Institute and Vancouver General Hospital. First septal perforator SCAD prevalence was 11 of 1490 (0.7%). Among 11 patients, age range was 38–64 years, 9 (82%) were female. Each presented with acute chest pain, troponin elevation, and non-ST-elevation MI diagnosis. Initial electrocardiogram demonstrated ischaemia in 5 (45%); septal wall motion abnormality was present in 4 (36%). Angiographic type 2 SCAD was present in 7 (64%) patients with S1 TIMI 3 flow in 7 (64%) and TIMI 0 flow in 2 (18%). Initial angiographic interpretation failed to recognize S1-SCAD in 6 (55%) patients (no culprit, n = 5, septal embolism, n = 1). First septal perforator SCAD diagnosis was established by review of initial coronary angiogram consequent to cardiovascular magnetic resonance (CMR) demonstrating focal septal late gadolinium enhancement with corresponding oedema (n = 3), occurrence of subsequent SCAD event (n = 2), or second angiogram showing healed S1-SCAD (n = 1). Patients were treated conservatively, each with ejection fraction &gt;50%. Conclusion  First septal perforator SCAD events may be overlooked at initial angiography and mis-diagnosed as ‘no culprit’ MI. First septal perforator SCAD prevalence is likely greater than reported herein and dependent on local expertise and availability of CMR imaging. Spontaneous coronary artery dissection events may occur in intra-myocardial coronary arteries, approaching the resolution limits of invasive coronary angiography.

Abstract 17356: Gender Differences in Clinical Presentation and Outcomes of Patients With Acute Myocardial Infarction and Spontaneous Coronary Artery Dissection: A Nationwide Inpatient Sample Matched Analysis

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Setri Fugar ◽  
Juliet A Yirerong ◽  
Alfred Solomon ◽  
Ahmed A Kolkailah ◽  
Tauseef Akthar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Gender Differences ◽  
Clinical Presentation ◽  
Artery Dissection ◽  
P Value ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Men And Women ◽  
Significant Difference

Introduction: Spontaneous Coronary Artery Dissection (SCAD) is reported to occur predominantly in young women. Gender differences in the clinical presentation and outcomes of patients with SCAD have not been studied on a population level. We sought to compare the in-hospital outcomes of men and women presenting with acute myocardial infarction (AMI) and SCAD. Methods: We identified patients from the National Inpatient Sample (NIS) between 2005 and 2015 who presented with primary diagnoses of AMI and SCAD. We identified SCAD with ICD-9 code 414.12. A 1:1 propensity-matched cohort was created to examine the outcomes between men and women. Primary endpoint was in-hospital mortality. Secondary endpoints included in-hospital cardiac and non-cardiac complications. Results: Of the 6617 (32017 weighted national estimates) patients with SCAD over the study period, majority were males 3667 (55.4%). Males were younger than females (60.32 yr vs. 61.59 yr) and presented more often with ST-elevation myocardial infarction (STEMI) (53.0% vs. 45.9% P=<0.001). Propensity matching yielded 2366 males and 2366 females. In the matched group, there was no significant difference in in-hospital mortality between males and females (OR 1.20 95% CI -0.93-1.54). With regards to in-hospital complications, ventricular tachycardia (V-Tach) was significantly less frequent in females as compared to males (8.0% vs. 10.1% OR 0.76 p-value 0.003). There was no significant difference between females and males in the frequency of other complications, including intracranial hemorrhage (0.2% vs 0.2% OR 1.45 p-value 0.50), GI bleed (1.8% vs 1.3% OR 1.35 p-value 0.13), cardiogenic shock (9.8% vs 9.7% OR 1.01 p-value 0.86), acute heart failure (3% vs 2.6% OR 1.18 p-value 0.26), ventricular fibrillation(vfib) (5.6% vs 6.0% OR 0.928 p-value 0.48) or stroke ( 1.5% vs 1.0% OR 1.535 p-value 0.06) Conclusion: In our large population-based analysis, compared to females, males were more likely to present with STEMI as compared to females. With the except of V-Tach, which was higher in males, there were no significant gender differences in hospital outcomes namely inpatient mortality, cardiogenic, Vfib or acute heart failure.

Spontaneous coronary artery dissection in association with cabergoline therapy

2021 ◽  
Vol 14 (2) ◽  
pp. e240022
Author(s):  
Zia Saleh ◽  
Susan Koshy ◽  
Vaninder Sidhu ◽  
Andrea Opgenorth ◽  
Janek Senaratne
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiac Risk ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Ergot Derivative

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognised cause of acute coronary syndrome. While numerous risk factors are associated with SCAD, one potential cause is coronary artery vasospasm. The use of cabergoline—an ergot derivative and dopamine agonist that may induce vasospasm—has been associated with SCAD in one other case report worldwide. Here, we describe SCAD in a 37-year-old woman on long-term cabergoline therapy with no other cardiac risk factors. Cabergoline-induced SCAD should be considered in patients presenting with an acute coronary syndrome who are treated with this medication.

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