Abstract 105: Rehospitalization After Admission With Myocardial Infarction and Spontaneous Coronary Artery Dissection

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Ahmed Elkaryoni ◽  
Kevin F Kennedy ◽  
Anna Grodzinsky ◽  
Sahar Naderi ◽  
Malissa J Wood ◽  
...  

Introduction: Spontaneous coronary artery dissection (SCAD) is one of the most common non-atherosclerotic causes of myocardial infarction (MI) in young patients, yet little is known about post-discharge outcomes. Given the high psychological stress of a SCAD diagnosis, we sought to understand the rehospitalization burden after SCAD so as to provide more prognostic data to SCAD patients. Methods: Using data from the Nationwide Readmission Database 2010-16, we identified patients 18-55 years of age hospitalized with MI with and without SCAD. We compared readmission over 1 year after index hospitalization for all-cause, MI, chest pain without MI, and heart failure. Cox proportional regression was used to examine factors associated with readmission, and we explored interactions of patient factors*SCAD to identify factors associated with differential risk of readmission in patients with SCAD. Results: Among 327,227 young patients admitted with an MI, 3704 (1.1%) had a diagnosis of SCAD. Patients with SCAD were more likely to be younger, women, have a higher burden of anxiety or depression, and longer length of stay compared with those without SCAD. While the risk of all-cause rehospitalization over 1 year was similar in those with versus without SCAD (KM-estimated rates: 22.3% vs. 24.1%; log-rank p=0.596, Figure), patients with SCAD were more likely to be rehospitalized for MI (4.9% vs. 4.2%, log-rank p=0.012) and chest pain without MI (3.6% vs. 2.8%, log-rank p=0.060) but less likely to be rehospitalized for heart failure (1.0 % vs. 1.8%, log-rank p=0.005). In the multivariable model, a diagnosis of SCAD was not associated with risk of rehospitalization (HR 1.00, 95% CI 0.92-1.08) nor was a diagnosis of SCAD associated with a differential effect of any of the patient factors on the risk of rehospitalization (all interaction p-values >0.05). Conclusion: Although patients with SCAD had a similar risk of rehospitalization compared with young patients with MI but without SCAD, we identified different patterns of hospitalization, which may be explained by the different underlying conditions. Further studies are needed to investigate possible interventions to reduce the high burden of post-SCAD rehospitalizations.

2022 ◽  
Vol 15 (1) ◽  
pp. e246393
Author(s):  
Filipa Costa Cascais ◽  
Ana Rita Pereira ◽  
Ana Rita Almeida ◽  
Luísa Rocha

A healthy 17-year-old boy was admitted to the emergency department presenting with a pressure-like sternal pain that started during exercise. His physical examination was normal. Twelve-lead ECG and transthoracic echocardiogram suggested a myocardial infarction. The patient was submitted to an invasive coronary angiography, which revealed a distal occlusion of the left anterior descending artery, due to a spontaneous coronary artery dissection. A balloon angioplasty was performed, with good results. Aetiological study did not discover any pathologic condition. Chest pain in paediatric age is a frequent complaint, despite not being usually caused by a serious condition. However, it is important to remember warning signs in order to diagnose life-threatening diseases, as soon as possible.


2014 ◽  
Vol 71 (3) ◽  
pp. 311-316
Author(s):  
Biljana Putnikovic ◽  
Ivan Ilic ◽  
Milos Panic ◽  
Aleksandar Aleksic ◽  
Radosav Vidakovic ◽  
...  

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.


2018 ◽  
Vol 12 (2) ◽  
pp. 105-107
Author(s):  
Samsun Nahar ◽  
Fatema Begum ◽  
Momenuzzaman ◽  
KN Khan

Spontaneous coronary artery dissection is a rather rare cause of myocardial infarction, chest pain, and sudden death.There are currently no known direct causes of this condition.Most of the reported dissections have occurred in the left anterior descending coronary artery.Herein, we report the case of a 58-year-old woman who presented at our institution with an acute ST-elevation myocardial infarction secondary to a spontaneous dissection of the right coronary artery. Primary PCIresolved the occlusion of the artery, and the patient was discharged from the hospital on medical therapy.University Heart Journal Vol. 12, No. 2, July 2016; 105-107


2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Kelly E Wingerter ◽  
Kimberly R O’Dell ◽  
Annemarie J Anglim ◽  
Alison L Bailey

Abstract Background  Acute myocardial infarction in pregnancy is occasionally due to spontaneous coronary artery dissection (SCAD). Although uncommon, the majority of cases of pregnancy-associated SCAD (pSCAD) has critical presentations with more profound defects that portend high maternal and foetal mortality, and frequently necessitate preterm delivery. This is a case of pSCAD with ongoing ischaemia that required temporary mechanical circulatory support (MCS) and emergent revascularization, while the pregnancy was successfully continued to early-term. Case summary  A 30-year-old woman G2P1 at Week 32 of gestation with no medical history, presented to the emergency department with severe chest pain. An electrocardiogram showed ST-segment elevation in the anterolateral leads. An emergent cardiac catheterization revealed dissection of the proximal left anterior descending (LAD) artery with TIMI (thrombolysis in myocardial infarction) 3 flow. Although initially stable, she later experienced recurrent chest pain and developed cardiogenic shock, necessitating MCS, and emergent revascularization. She was stabilized and remained closely monitored in the hospital prior to vaginal delivery at early-term. Discussion  This case of pSCAD at Week 32 of gestation complicated by refractory ischaemia illustrates the complexity of management, which requires a multi-disciplinary team to reduce both maternal and foetal mortality. Conservative management of SCAD, while preferred, is not always possible in the setting of ongoing ischaemia, particularly if complicated by cardiogenic shock. A thorough weighing of risks vs. benefits and ongoing discussions among multiple subspecialists in this case allowed for the stabilization of the patient and subsequent successful early-term delivery.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giorgio Oliverio ◽  
Valentina Volpato ◽  
Michele Tomaselli ◽  
Sergio Caravita ◽  
Camilla Torlasco ◽  
...  

Abstract Aims We present the case of a 25 years-old patient, presented to the Emergency Department for chest pain and epigastralgia complicated by vomiting. Symptoms started about 30 h before, afterwards an effort. The patient did not have any known cardiovascular risk factors (except for sporadic consumption of cannabis) and family medical history was negative for premature cardiovascular disease or sudden cardiac death. His past medical history was unremarkable. Methods and results Clinical examination was normal. ECG was suggestive for subacute anterior ST-elevation myocardial infarction (QS in V1–V4 leads with ST segment elevation and biphasic T-waves in V4–V6) and was accompanied by significant elevation of myocardial necrosis biomarkers (hsTnT 3416 ng/l, n.v. <15). Echocardiography revealed a severely reduced left ventricular ejection fraction (LVEF = 30%) with regional wall motion abnormalities (apical and septal akinesia, and anterior mid-ventricular segment hypokinesia). Coronary angiography was suggestive for a dissection of the proximal-to-mid left anterior descending artery. Dissection flap, subocclusion of the first septal branch, and intramural thrombosis were noted. Direct stenting with drug-eluting stent was successful, with thrombolysis in myocardial infarction (TIMI) flow grade 3. The patient was started on dual antiplatelet treatment (aspirin and ticagrelor), ACE-inhibitors, beta blockers, and spironolactone. Further testing ruled out other conditions that may be associated with spontaneous coronary artery dissection (autoimmune diseases, including vasculitis, connective tissue disease, coagulative disorders). The clinical course was complicated by pericarditis and the development of LV apical thrombus. So, patient was started on anticoagulation (warfarin) with subsequently downgrading from ticagrelor to clopidogrel. Echocardiographic follow-up documented a progressive improvement of LVEF (50%), and global longitudinal strain (GLS −15%) with persistence of wall motion abnormalities in the apical and septal segments. Partial resolution of intracavitary thrombi was documented. CMR revealed LV apical aneurysm. Moreover, the use of dedicated sequences showed transmural late gadolinium enhancement in akinetic segments, and fatty metaplasia of the apical portion of the anterior wall and anterior septal wall. Finally, early gadolinium enhancement imaging, confirmed the persistence of LV stratified apical thrombus. Conclusions Spontaneous coronary artery dissection (SCAD) is an underdiagnosed and frequent cause of acute coronary syndrome (ACS) in young-to-middle aged patients, particularly women; therefore, even in young people, a chest pain episode suggestive for an ischaemic cause should never be underestimated. Cardiac magnetic resonance is the most accurate method to evaluate the sequelae of myocardial infarction (including LV size and function, presence of fatty metaplasia, extent and transmurality of ischaemic scar, presence of thrombi), to aid in differential diagnosis and to define prognosis and guide the therapeutic management.


2021 ◽  
Vol 7 (1) ◽  
pp. 22-26
Author(s):  
Roxana-Daiana Lazar ◽  
Abigaela Rus ◽  
Cosmin Tolescu ◽  
Renata Gerculy ◽  
Diana Opincariu ◽  
...  

Abstract Introduction: Spontaneous coronary artery dissection (SCAD) represents a very rare and poorly understood condition that is gaining recognition as an important cause of myocardial infarction, especially among young women. The pathogenesis of SCAD is not well established yet, but several theories have been proposed. Case presentation: We report the case of a 25-year-old woman without any history of cardiovascular disease who presented with acute anterior ST-elevation myocardial infarction (STEMI) due to the luminal obstruction generated by an intramural hematoma from a SCAD of the left main coronary artery, which was successfully treated by coronary artery stenting. Additionally, the patient presented anomalies of coronary origins (ACO) with separate emergences of the left anterior descending (LAD) artery from the left coronary cusp and the left circumflex artery (LCX) from the right coronary cusp, with no apparent clinical significance. Conclusion: SCAD should always be included in the differential diagnosis of young patients presenting with STEMI. In case of prompt diagnosis, SCAD-STEMI patients are successfully treated with percutaneous coronary intervention (PCI). Moreover, it is of vital importance to identify variants of ACO, even without clinical relevance at the moment of the acute event, in order to initiate an appropriate management, since ACO increases the risk of routine PCI.


2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Vidhushei Yogeswaran ◽  
Satvik Ramakrishna ◽  
John S. MacGregor ◽  
Lucas Zier ◽  
Nora Goldschlager

Spontaneous Coronary Artery Dissection (SCAD) is an important cause of myocardial infarction that typically affects women without traditional cardiovascular risk factors. It is the most common cause of myocardial infarction in pregnant and postpartum women. SCAD is often underdiagnosed due to the lack of clinician familiarity, and patients with pregnancy-associated SCAD often have more severe clinical presentations than those without. We present a case of SCAD in a multiparous woman who presented with acute chest pain in the postpartum period.


Author(s):  
Scott W Sharkey ◽  
Mesfer Alfadhel ◽  
Christina Thaler ◽  
David Lin ◽  
Meagan Nowariak ◽  
...  

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 >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.


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