scholarly journals Spontaneous Coronary Artery Dissection

2015 ◽  
Vol 10 (3) ◽  
pp. 142
Author(s):  
Jacqueline Saw ◽  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Artery Wall ◽  
Coronary Artery Dissection ◽  
Intracoronary Imaging ◽  
Younger Women

Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary artery wall that is now recognised as an important cause of myocardial infarction, especially in younger women. SCAD can be elusive on coronary angiography and clinician familiarity with non-pathognomonic angiographic SCAD variants and the use of intracoronary imaging will improve diagnosis. Conservative management and long-term cardiovascular follow-up are typically recommended.

scholarly journals Spontaneous coronary artery dissection: Rare but challenging

2014 ◽  
Vol 71 (3) ◽  
pp. 311-316
Author(s):  
Biljana Putnikovic ◽  
Ivan Ilic ◽  
Milos Panic ◽  
Aleksandar Aleksic ◽  
Radosav Vidakovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Flow ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome

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.

Spontaneous Coronary Artery Dissection in the Gulf: G-SCAD Registry

Angiology ◽  
2020 ◽  
Vol 72 (1) ◽  
pp. 32-43
Author(s):  
Amin Daoulah ◽  
Salem M. Al-Faifi ◽  
Sameer Alhamid ◽  
Ali A. Youssef ◽  
Mohammed Alshehri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Gulf Countries ◽  
Percutaneous Coronary ◽  
St Elevation

Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events ( P = .029).

Spontaneous Coronary Artery Dissection: Does Being Unemployed Matter? Insights from the G‐SCAD registry

2020 ◽  
Vol 16 ◽  
Author(s):  
Amin Daoulah ◽  
Salem M. Al-Faifi ◽  
William T. Hurley ◽  
Abdulaziz Alasmari ◽  
Mohammed Ocheltree ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Cardiac Events ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Number Of Patients

Background: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) and sudden cardiac death. Physical or emotional stressors are the most commonly reported triggers for SCAD. Unemployment has been identified as a source of emotional stress and linked to poor mental and physical health. Objective: To examine the association between employment status and in-hospital and follow-up adverse cardiovascular events in patients with SCAD. Methods: We conducted a retrospective, multi-center, observational study of patients undergoing coronary angiography for ACS between January 2011 and December 2017. The total number of patients enrolled was 198,000. Patients were diagnosed with SCAD based on angiographic and intravascular imaging modalities whenever available. There were 83 patients identified with SCAD from 30 medical centers in 4 Arab gulf countries. In-hospital (myocardial infarction, percutaneous intervention, ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, internal cardioverter/defibrillator placement, dissection extension) and follow-up (myocardial infarction, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were compared among those who were employed and those who were not. Results: The median age of patients in the study was 44 (37- 55) years. There were 42 (50.6%) female patients, and 41 (49.4) male patients. Of the cohort, 50 (60%) of the patients were employed and the remaining 33 (40%) were unemployed. 66% of all men were employed and 76% of all women were unemployed. After adjusting for gender unemployment was associated with worse in-hospital and follow-up cardiac events (adjusted OR 7.1, [1.3, 37.9]), p = 0.021. Conclusion: Adverse cardiovascular events were significantly worse for patients with SCAD who were unemployed.

Differences in revascularization strategy and outcomes in ST-elevation and non-ST-elevation myocardial infarction with spontaneous coronary artery dissection

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Inohara ◽  
M Alfadhel ◽  
A Starovoytov ◽  
G.B John Mancini ◽  
J Saw
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Funding Source ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Clinical Presentations ◽  
Increased Risk ◽  
St Elevation

Abstract Background Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in young to middle-aged women. However, the role of revascularization for SCAD, especially percutaneous coronary intervention (PCI), remains controversial. Purpose To compare revascularization strategies and outcomes in SCAD patients presenting with ST-elevation MI (STEMI) vs. unstable angina or non-STEMI (UA/NSTEMI). Methods We analyzed SCAD patients who presented acutely between June 2014 and June 2018 to 22 centers participating in the Canadian SCAD Cohort Study. We compared treatment patterns and clinical outcomes in SCAD patients with an initial clinical presentation of STEMI vs. UA/NSTEMI. We assessed follow-up major adverse cardiovascular event (MACE) rate, a composite of all-cause death, MI, and stroke. The impact of revascularization on MACE was also evaluated according to clinical presentations (STEMI vs. UA/NSTEMI). Results Among 750 SCAD patients (mean age 51.7±10.5 years; 88.5% were women), 234 (31.2%) presented with STEMI. In the STEMI group, left anterior descending artery was more commonly involved (62.0% vs. 47.5%, p<0.001) and TIMI 0 flow was more frequently observed (24.8% vs. 7.2%, p<0.001). A total of 27.8% of STEMI patients were treated with revascularization (98.5% PCI), whereas only 8.7% of UA/NSTEMI patients were revascularized (93.3% PCI). For STEMI patients, 93.9% were planned procedures, whereas, for UA/NSTEMI patients, 71.1% were planned revascularization. Successful or partially successful PCI was 65.5% for STEMI and 76.9% for UA/NSTEMI (p<0.001). The median follow-up period was 850 (interquartile range: 619–1096) days. MACE rate was not different between STEMI and UA/NSTEMI (UA/NSTEMI as a reference: hazard ratio [HR] 1.08, 95% confidence interval [CI] 0.70–1.68, p=0.72). Regardless of clinical presentations, revascularization was associated with increased risk of MACE (STEMI: HR 2.57, CI 1.25–5.25, p=0.01; UA/NSTEMI: HR 5.41, CI 3.19–9.19, p<0.001). The association of revascularization and increased risk of MACE was more prominent in UA/NSTEMI than in STEMI (Figure), but it did not reach statistical significant (P for interaction = 0.09). Conclusions In SCAD patients, long-term clinical outcome was not different between STEMI and UA/NSTEMI presentations. Revascularization was more frequently performed with STEMI; however, regardless of clinical presentations, revascularization was associated with worse clinical outcomes. Careful patient selection for revascularization is key for SCAD patients and further studies are needed to clarify selection criteria. Revasc and MACE by presentation Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research

Long-term follow-up of spontaneous coronary artery dissection treated with bioresorbable scaffolds

2019 ◽  
Vol 14 (13) ◽  
pp. 1403-1405 ◽  
Author(s):  
Fernando Macaya ◽  
Pablo Salinas ◽  
Nieves Gonzalo ◽  
Santiago J. Camacho-Freire ◽  
Robert Jackson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Bioresorbable Scaffolds ◽  
Long Term Follow Up

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 >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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