Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes

Saw, Jacqueline; Starovoytov, Andrew; Humphries, Karin H.; Sheth, Tej; So, Derek; Minhas, Kunal; Brass, Neil; Lavoie, Andrea; Bishop, Helen; Lavi, Shahar; Pearce, Colin; Renner, Suzanne; Madan, Mina; Welsh, Robert C.; Lutchmedial, Sohrab; Vijayaraghavan, Ram; Aymong, Eve; Har, Bryan; Ibrahim, Réda; Gornik, Heather L.; Ganesh, Santhi K.; Buller, Christopher E.; Matteau, Alexis; Martucci, Giuseppe; Ko, Dennis T.; Mancini, G.B. John

doi:10.1093/eurheartj/ehz007

Cited by 330 publications

(485 citation statements)

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“…Hemodynamic stability can dictate further management with unstable patients requiring urgent percutaneous intervention or CABG. In a recent review article, 84% of patients were managed conservatively, 15% with percutaneous intervention, and 1% required urgent CABG [17]. Complications such as the iatrogenic extension of the dissection and true lumen occlusion should be considered before proceeding with the early invasive strategy [5][6][18][19].…”

Section: Discussionmentioning

confidence: 99%

Slit in the Coronaries: A Case of Spontaneous Coronary Artery Dissection

Bath

Aggarwal

Gupta

et al. 2019

Cureus

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Spontaneous coronary artery dissection (SCAD) is a noniatrogenic epicardial coronary artery dissection unrelated to an atherosclerotic disease process. SCAD is responsible for a small percentage of acute coronary syndrome (ACS) cases. The left anterior descending (LAD) artery is the most common artery affected in SCAD, although any coronary artery can be affected. We present an interesting case of SCAD presenting as an ST-elevation myocardial infarction complicated with dissection extending to the left main and distal LAD requiring emergent coronary artery bypass grafting. Our case emphasizes the importance of considering SCAD as a cause for ACS, especially in young patients with minimal atherosclerotic risk factors. Also, a very high recurrence rate demands strict follow-up and multidisciplinary decision making in the population impacted with this rare entity.

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Section: Discussionmentioning

confidence: 99%

Slit in the Coronaries: A Case of Spontaneous Coronary Artery Dissection

Bath

Aggarwal

Gupta

et al. 2019

Cureus

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“…The optimal management of SCAD is challenging, and to the best of our knowledge, no randomized controlled trials are available in the field. A conservative approach is recommended, with the exception of ongoing ischemia involving large coronary territories, hemodynamic instability, or life-threatening ventricular arrhythmias (1,2). Accordingly, PCI may be harmful due to the increased risk of iatrogenic dissection propagation or vessel occlusion (1).…”

Section: Discussionmentioning

confidence: 99%

“…Sudden cardiac death is a common mode of mortality in patients with PAH, and it may be related with mechanical complications (1). The severe LMCA compression rate was 8.2% in a recent study and required intervention in most of the patients (2). The LMCA compression risk is related to the PA diameter.…”

Section: Discussionmentioning

confidence: 99%

“…Idiopathic, iatrogenic, infectious or connective tissue diseases, and vasculitis can cause a PA aneurysm, but the majority of the cases are related with congenital heart disease and PAH (3). As the LMCA compression can exist without anginal symptoms, physicians should be aware of the sudden death risk, and computed tomography should be performed to define the LMCA compression in patients at risk; particularly if the PA diameter is over 40 mm, ensuring the existence of a PA aneurysm (1,2). Recent evidence indicates the coronary stenting as a viable option for resolution of LMCA compression (2).…”

Section: Discussionmentioning

confidence: 99%

“…As the LMCA compression can exist without anginal symptoms, physicians should be aware of the sudden death risk, and computed tomography should be performed to define the LMCA compression in patients at risk; particularly if the PA diameter is over 40 mm, ensuring the existence of a PA aneurysm (1,2). Recent evidence indicates the coronary stenting as a viable option for resolution of LMCA compression (2). But in this case, a complete obstruction of LMCA was not amenable to stenting, so a surgical intervention was the only option.…”

Section: Discussionmentioning

confidence: 99%

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Young woman with cardiac arrest due to spontaneous coronary artery dissection

et al. 2019

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Diagnosis and Treatment of Acute Coronary Syndromes

Bhatt

Lopes

Harrington

2022

JAMA

348

164

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cute coronary syndromes (ACS) are defined by a sudden reduction in blood supply to the heart and include ST-segmentelevationmyocardialinfarction(STEMI)andnon-ST-segment elevation ACS (NSTE-ACS). NSTE-ACS consists of non-STsegment elevation myocardial infarction (NSTEMI) and unstable angina. [1][2][3][4] Each year, an estimated more than 7 million people are diagnosed with ACS worldwide, including more than 1 million patients hospitalized in the US for ACS. 5,6 Approximately 5% of patients with ACS die before hospital discharge. 2,[5][6][7] Coronary atherosclerotic plaque rupture with thrombus formation accounts for approximately 70% of fatal acute MIs and sudden coronary deaths. 8 This review summa-rizes current evidence regarding epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and prognosis of ACS (Box). MethodsWe searched PubMed for English-language studies of the epidemiology, pathophysiology, diagnosis, treatment, and prognosis of ACS that were published from January 1, 2000, to January 1, 2022. A total of 1094 articles were retrieved with the search. We manually inspected the reference lists of selected articles for other relevant IMPORTANCE Acute coronary syndromes (ACS) are characterized by a sudden reduction in blood supply to the heart and include ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina. Each year, an estimated more than 7 million people in the world are diagnosed with ACS, including more than 1 million patients hospitalized in the US.OBSERVATIONS Chest discomfort at rest is the most common presenting symptom of ACS and affects approximately 79% of men and 74% of women presenting with ACS, although approximately 40% of men and 48% of women present with nonspecific symptoms, such as dyspnea, either in isolation or, more commonly, in combination with chest pain. For patients presenting with possible ACS, electrocardiography should be performed immediately (within 10 minutes of presentation) and can distinguish between STEMI and non-ST-segment elevation ACS (NSTE-ACS). STEMI is caused by complete coronary artery occlusion and accounts for approximately 30% of ACS. ACS without significant ST-segment elevation on electrocardiography, termed NSTE-ACS, account for approximately 70% of ACS, are caused by partial or intermittent occlusion of the artery and are associated with ST-segment depressions (approximately 31%), T-wave inversions (approximately 12%), ST-segment depressions combined with T-wave inversions (16%), or neither (approximately 41%). When electrocardiography suggests STEMI, rapid reperfusion with primary percutaneous coronary intervention (PCI) within 120 minutes reduces mortality from 9% to 7%. If PCI within 120 minutes is not possible, fibrinolytic therapy with alteplase, reteplase, or tenecteplase at full dose should be administered for patients younger than 75 years without contraindications and at half dose for patients 75 years or older (or streptokinase at full dose if cost is a consideration), followed by tran...

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Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes

Abstract: AimsSpontaneous coronary artery dissection (SCAD) was underdiagnosed and poorly understood for decades. It is increasingly recognized as an important cause of myocardial infarction (MI) in women. We aimed to assess the natural history of SCAD, which has not been adequately explored.

Cited by 330 publications

References 27 publications

Slit in the Coronaries: A Case of Spontaneous Coronary Artery Dissection

Slit in the Coronaries: A Case of Spontaneous Coronary Artery Dissection

Young woman with cardiac arrest due to spontaneous coronary artery dissection

Diagnosis and Treatment of Acute Coronary Syndromes

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