Young women undergoing percutaneous coronary intervention for spontaneous coronary artery dissection

Objectives. To compare outcomes of percutaneous coronary intervention (PCI) in spontaneous coronary artery dissection (SCAD) patients versus conservative therapy. Background. SCAD is an important cause of myocardial infarction (MI) in young-to-middle-aged women. Percutaneous coronary intervention (PCI) is often pursued, but outcomes compared to conservative therapy are unclear. Methods. 403 nonatherosclerotic SCAD patients were enrolled between 2011 and 2017 and prospectively followed up in our Vancouver General Hospital registries. Detailed baseline, hospital, PCI, and outcomes were recorded. We explored the outcomes of SCAD patients who underwent PCI during their initial presentation. Results. PCI was performed in 75 patients, the average age was 48.9 ± 10.1 yrs, and 94.7% were women. All presented with MI; 50.7% STEMI, 49.3% NSTEMI, and 13.3% had VT/VF. PCI was successful in 34.7%, partially successful in 37.3%, and unsuccessful in 28.0%. Stents were deployed in 73.3%, 16.0% had balloon angioplasty alone, 10.7% had wiring attempts only, and 5.3% required bailout surgery. Major adverse cardiovascular event rates (MACE) were significantly higher with the PCI group in hospital (29.3% versus 2.8%, p < 0.001 ), and at median follow-up of 3.7 yrs (58.7% versus 22.6% ( p < 0.001 ) compared to the non-PCI group. Conclusion. PCI in SCAD patients was associated with high failure rate and MACE in hospital and at long-term follow-up. These findings support the recommendation of conservative therapy as first-line management unless high-risk features are present.

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Percutaneous Coronary Intervention for Spontaneous Coronary Artery Dissection under Intravascular Ultrasound Guidance

International Journal of Cardiovascular Research ◽

10.4172/2324-8602.1000262 ◽

2016 ◽

Vol 05 (02) ◽

Author(s):

Michiya Kageyama ◽

Fumitake Yamauchi

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Intravascular Ultrasound ◽

Ultrasound Guidance ◽

Coronary Intervention ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Percutaneous Coronary

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Progression of left anterior descending artery dissection due to stent implantation for spontaneous coronary artery dissection of left circumflex artery: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz173 ◽

2019 ◽

Vol 3 (4) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Kensuke Matsushita ◽

Jessica Ristorto ◽

Olivier Morel ◽

Patrick Ohlmann

Keyword(s):

Optical Coherence Tomography ◽

Percutaneous Coronary Intervention ◽

Chest Pain ◽

Coronary Artery ◽

Coronary Intervention ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Percutaneous Coronary ◽

Intimal Tear

Abstract Background Spontaneous coronary artery dissection (SCAD) is a rare disease that predominantly affects woman. Percutaneous coronary intervention (PCI) is recommended only in patients with ongoing ischaemia because it carries a high risk of procedural complications in SCAD patients. Case summary A 51-year-old woman was admitted to our institution owing to severe chest pain. Coronary angiography showed a diffuse narrowing and radiolucent luminal flap which runs parallel to the vessel wall in the proximal left circumflex coronary artery and SCAD was diagnosed. After PCI was undertaken, optical coherence tomography disclosed a circular haematoma at the stent distal segment and an intimal tear at the distal left main coronary artery. A conservative approach was decided owing to patient stability without evidence of ongoing ischaemia and normal coronary flow. Thirty minutes later, the patient started to complain of chest pain with the ST-segment elevation in leads I, aVL, and V2–3. Coronary angiography demonstrated a total occlusion of the second diagonal brunch and double lumen morphology at the proximal-potion of left anterior descending with TIMI2 distal flow suggesting the extension of coronary dissection. Optical coherence tomography imaging revealed that the entry door of the dissection was located where the small intimal tear was found. Percutaneous coronary intervention was successfully performed, and the patient was discharged without any complication. Discussion Although the underlying mechanism of recurrent SCAD remain largely unknown, our case suggests that the residual inlet of the dissection may associate with the extension of the coronary dissection.

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