Clinical outcomes by angiographic type of spontaneous coronary artery dissection

Mori, Ricardo; Macaya, Fernando; Giacobbe, Federico; Salinas, Pablo; Pavani, Marco; Boi, Alberto; Bettari, Luca; Rolfo, Cristina; Porto, Italo; Gonzalo, Nieves; Varbella, Ferdinando; Cerrato, Enrico; Escaned, Javier

doi:10.4244/eij-d-20-01275

Cited by 24 publications

(12 citation statements)

References 14 publications

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“…This is evidence of significant morbidity in SCAD, especially as age and cardiovascular risk factors have not been adjusted for, due to the relatively small study population with SCAD. In three recently published European SCAD-studies16–18 the unplanned reangiography was 4%, 8.5% and 5.3%, respectively. This study found a death rate of 2.7% after a median follow-up of 17.3 months indicating a higher mortality than in previous studies.…”

Section: Discussionmentioning

confidence: 95%

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Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register

et al. 2022

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ObjectivesThe aim of this study was to conduct a nationwide all comer description of incidence, contemporary management and outcome in Swedish spontaneous coronary artery dissection (SCAD) patients. The incidence of SCAD as well as the management and outcome of these patients is not well described.DesignA nationwide observational study.Participants and settingAll patients with SCAD registered in the Swedish Coronary Angiography and Angioplasty Register from 2015 to 2017 were included. The index angiographies of patients with registered SCAD were re-evaluated at each centre to confirm the diagnosis. Patients with non-SCAD myocardial infarction (MI) (n=32 601) were used for comparison.Outcome measuresOutcomes included all-cause mortality, reinfarction or acute coronary reangiography.ResultsThis study found 147 SCAD patients, rendering an incidence of 0.74 per 100 000 per year and a prevalence of 0.43% of all MIs. The average age was 52.9 years, 75.5% were women and 47.6% presented with ST-segment elevation MI. Median follow-up time for major adverse cardiac event was 17.3 months. Percutaneous coronary intervention was attempted in 40.1% of SCAD patients and 30.6% received stent. The use of antithrombotic agents was similar between the groups and there was no difference regarding outcomes, 10.9% vs 13.4%, p=0.75. Mortality was lower in SCAD patients, 2.7% vs 8.0%, p=0.03, whereas SCAD patients more often underwent acute reangiography, 9.5% vs 4.6%, p<0.01.ConclusionIn this nationwide, all comer Swedish study, the overall incidence of SCAD was low, including 25% men which is more and in contrast to previous studies. Compared with non-SCAD MI, SCAD patients were younger, with lower cardiovascular risk burden, yet suffered substantial mortality and morbidity and more frequently underwent acute coronary reangiography.

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Section: Discussionmentioning

confidence: 95%

“…Although better recognised recently,16–18 SCAD still remains insufficiently studied as there are no nationwide reports on SCAD MIs relative to type 1 MIs, registered in the same period.…”

Section: Introductionmentioning

confidence: 99%

Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register

et al. 2022

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“…Details on study protocol and procedures, as well as end points definitions, have been previously reported. 13,14 Briefly, the DISCO IT/SPA (Dissezioni Spontanee Coronariche Italy/ Spain) is a multicenter, observational registry in which patients with SCAD are retrospectively enrolled across 26 Italian and Spanish centers. The study was approved by the institutional review boards.…”

Section: Methodsmentioning

confidence: 99%

Interventional Versus Conservative Strategy in Patients With Spontaneous Coronary Artery Dissections: Insights From DISCO Registry

Benenati

Giacobbe

Zingarelli

et al. 2023

Circ: Cardiovascular Interventions

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Background: The optimal management of patients with spontaneous coronary artery dissection remains debated. Methods: Patients enrolled in the DISCO (Dissezioni Spontanee Coronariche) Registry up to December 2020 were included. The primary end point was major adverse cardiovascular events, a composite of all-cause death, nonfatal myocardial infarction, and repeat percutaneous coronary intervention (PCI). Independent predictors of PCI and medical management were investigated. Results: Among 369 patients, 129 (35%) underwent PCI, whereas 240 (65%) were medically managed. ST-segment–elevation myocardial infarction (68% versus 35%, P <0.001), resuscitated cardiac arrest (9% versus 3%, P <0.001), proximal coronary segment involvement (32% versus 7%, P <0.001), and Thrombolysis in Myocardial Infarction flow 0 to 1 (54% versus 20%, P <0.001) were more frequent in the PCI arm. In-hospital event rates were similar. Between patients treated with PCI and medical therapy, there were no differences in terms of major adverse cardiovascular events at 2 years (13.9% versus 11.7%, P =0.467), all-cause death (0.7% versus 0.4%, P =0.652), myocardial infarction (9.3% versus 8.3%, P =0.921) and repeat PCI (12.4% versus 8.7%, P =0.229). ST-segment–elevation myocardial infarction at presentation (odds ratio [OR], 3.30 [95% CI, 1.56–7.12]; P =0.002), proximal coronary segment involvement (OR, 5.43 [95% CI, 1.98–16.45]; P =0.002), Thrombolysis in Myocardial Infarction flow grade 0 to 1 and 2 (respectively, OR, 3.22 [95% CI, 1.08–9.96]; P =0.038; and OR, 3.98 [95% CI, 1.38–11.80]; P =0.009) and luminal narrowing (OR per 5% increase, 1.13 [95% CI, 1.01–1.28]; P =0.037) were predictors of PCI, whereas the 2B-angiographic subtype predicted medical management (OR, 0.25 [95% CI, 0.07–0.83]; P =0.026). Conclusions: Clinical presentation and procedural variables drive the choice of the initial therapeutic approach in spontaneous coronary artery dissection. If PCI is needed, it seems to be associated with a similar risk of short-to-mid-term adverse events compared to medical treatment. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04415762.

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“…-Type 3 (5%): variably long and diffuse stenosis that mimics atherosclerosis. Intracoronary imaging with optical coherence tomography (OCT)/intravascular ultrasound (IVUS) may clarify these cases (29).…”

Section: Clinical Presentationmentioning

confidence: 99%

Optical Coherence Tomography and Coronary Dissection: Precious Tool or Useless Surplus?

Barbieri

d’Errico

Avallone

et al. 2022

Front. Cardiovasc. Med.

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Spontaneous coronary artery dissection (SCAD) is a rare clinical condition, but frequently manifested as acute myocardial infarction. In this particular setting, in recent years, optical coherence tomography (OCT) has been established as a possible diagnostic method due to the high spatial resolution (10–20 μm), which can visualize the different layers of coronary vessels. OCT can better analyze the “binary” or double lumen morphology, typical of this entity. Furthermore, it can identify the entrance breach and the circumferential and longitudinal extension of the lesion. However, we have to emphasize that this technique is not free from complications. OCT could further aggravate a dissection or exacerbate a new intimal tear. Therefore, the use of OCT in the evaluation of SCAD should be defined by balancing the diagnostic benefits versus procedural risks. Moreover, we underline that as SCAD is a rare condition and OCT is a recently introduced technique in clinical practice, limited data is available in literature.

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Clinical outcomes by angiographic type of spontaneous coronary artery dissection

Cited by 24 publications

References 14 publications

Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register

Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register

Interventional Versus Conservative Strategy in Patients With Spontaneous Coronary Artery Dissections: Insights From DISCO Registry

Optical Coherence Tomography and Coronary Dissection: Precious Tool or Useless Surplus?

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