Lack of Association of Spontaneous Coronary Artery Dissection With Autoimmune Disease

Kronzer, Vanessa L.; Tarabochia, Alex D; Romero, Angie S. Lobo; Tan, Nicholas; O’Byrne, Thomas J.; Crowson, Cynthia S.; Turley, Tamiel N.; Myasoedova, Elena; Davis, John M.; Raphael, Claire E.; Gulati, Rajiv; Hayes, Sharonne N.; Tweet, Marysia S.

doi:10.1016/j.jacc.2020.09.533

Cited by 33 publications

(24 citation statements)

References 62 publications

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“…Eosinophilic infiltration was not a consistent global feature across the SCAD case series as described in eosinophilic coronary periarteritis 28 . Our findings are consistent with the fact that, although inflammatory disorders are often reported as a predisposing condition in SCAD 11 , rates of inflammatory diseases are probably similar to the general population 29,30 .…”

Section: Discussionsupporting

confidence: 91%

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Vascular histopathology and connective tissue ultrastructure in spontaneous coronary artery dissection: pathophysiological and clinical implications

Margaritis

Saini

Baranowska-Clarke

et al. 2021

Cardiovascular Research

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Aims Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndromes and in rare cases sudden cardiac death (SCD). Connective tissue abnormalities, coronary inflammation, increased coronary vasa vasorum density and coronary fibromuscular dysplasia have all been implicated in the pathophysiology of SCAD but have not previously been systematically assessed. We designed a study to investigate the coronary histological and dermal collagen ultrastructural findings in SCAD. Methods and Results 36 autopsy SCAD cases were compared with 359 SCAD survivors. Coronary and myocardial histology and immunohistochemistry were undertaken. Transmission electron microscopy (TEM) of dermal extracellular matrix components (ECM) of n = 31 SCAD survivors and n = 16 healthy volunteers were compared. Autopsy cases were more likely male (19% versus 5%; p = 0.0004) with greater proximal left coronary involvement (56% versus 18%; p < 0.0001) compared to SCAD survivors. N = 24 (66%) of cases showed no myocardial infarction on macro- or microscopic examination consistent with arrhythmogenic death. There was significantly (p < 0.001) higher inflammation in cases with delayed-onset death vs sudden death and significantly more inflammation surrounding the dissected vs. non-dissected vessel segments. N = 17 (47%) cases showed limited intimal fibro-elastic thickening but no features of fibromuscular dysplasia and no endothelial or internal elastic lamina abnormalities. There were no differences in vasa vasorum density between SCAD and control cases. TEM revealed no general ultrastructural differences in ECM components or markers of fibroblast metabolic activity. Conclusions Assessment of SCD requires careful exclusion of SCAD, particularly in cases without myocardial necrosis. Peri-coronary inflammation in SCAD is distinct from vasculitides and likely a reaction to, rather than a cause for SCAD. Coronary fibromuscular dysplasia or increased vasa vasorum density do not appear pathophysiologically important. Dermal connective tissue changes are not common in SCAD survivors. Translational Perspective SCAD, especially of distal coronary territories should be carefully assessed at post mortem in SCD cases, even where there are no signs of myocardial infarction. The immediate cause of SCAD is likely to be the development of a spontaneous intramural haematoma rather than an intimal disruption or ‘tear’. This does not seem to be directly related to increased vasa vasorum density, coronary fibromuscular dysplasia or local inflammation (except as a response to injury). Although SCAD is rarely associated with hereditary connective tissue disorders, there does not seem to be a more generalizable global connective tissue ultrastructural abnormality in most cases.

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Section: Discussionsupporting

confidence: 91%

“… 28 Our findings are consistent with the fact that, although inflammatory disorders are often reported as a predisposing condition in SCAD, 11 rates of inflammatory diseases are probably similar to the general population. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Vascular histopathology and connective tissue ultrastructure in spontaneous coronary artery dissection: pathophysiological and clinical implications

Margaritis

Saini

Baranowska-Clarke

et al. 2021

Cardiovascular Research

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“…SCCAD is an infrequent but potentially devastating cause of stroke; its pathophysiologic mechanisms remain somewhat unclear (1). Although some case studies had discussed the possible relationship between SCCAD and autoimmune diseases, available data were sparse and inconsistent (3,(6)(7)(8)14). In our cohort study on SCCAD patients, a higher ratio of autoimmune diseases was observed.…”

Section: Discussionmentioning

confidence: 61%

“…A recent case-control study had also shown that anti-thyroid autoimmunity might be involved in the process of local inflammation related to SCCAD occurrence (6). However, these were not consistent with other studies (7,8). Due to the limited data, it is unclear whether autoimmune diseases are associated with SCCAD or just coincident with SCCAD.…”

Section: Introductionmentioning

confidence: 83%

Association Between Autoimmune Diseases and Spontaneous Cervicocranial Arterial Dissection

Song

Yang

et al. 2022

Front. Immunol.

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A series of biopsies and reports showed autoimmune diseases might be involved in the process of local inflammation related to spontaneous cervicocranial arterial dissection (SCCAD) occurrence. This retrospective case-control study examined the association between SCCADs and autoimmune diseases in patients and control subjects from 2014 to 2020. SCCAD patients and age/sex-matched control subjects were recruited, and clinical data were collected. SCCAD was confirmed by digital subtraction angiography or high-resolution magnetic resonance imaging. The study included 215 SCCAD patients and 430 control subjects. Totally, 135 (62.8%) of the 215 cases were found SCCAD in the anterior circulation, 26 (12.0%) patients involved multiple vessels. Autoimmune disease occurred in 27 (12.6%) cases with SCCAD and 4 (0.9%) control subjects (p<0.001). A conditional multivariable logistic regression model was used to calculate the odds ratio for SCCAD among patients with a history of autoimmune disease, adjusting for hypertension, diabetes, hyperlipidemia, and smoking. After adjustment, autoimmune diseases were associated with SCCAD (p<0.001). After sub-analysis by a similar modeling strategy, significant associations were still observed in different subgroups, such as female group and male group as well as intramural hematoma (IMH) group and Non-IHM group. The association of SCCAD with autoimmune disease suggested that autoimmune mechanisms may be involved in some etiologies of SCCAD.

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“…4,5 Furthermore, there is evidence that the incidence of SCAD has increased during the past decades. 6…”

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confidence: 99%

Prevalence of Cervical Artery Abnormalities on CTA in Patients with Spontaneous Coronary Artery Dissection: Fibromuscular Dysplasia, Dissection, Aneurysm, and Tortuosity

Benson

Lehman

Verdoorn

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Little is known about associations between spontaneous coronary artery dissection and cervical artery abnormalities. This study sought to assess the prevalence of cervical artery abnormalities among patients with spontaneous coronary artery dissection. MATERIALS AND METHODS:A retrospective analysis was completed of patients who underwent CTA neck imaging as part of arterial assessment following the diagnosis of spontaneous coronary artery dissection. The internal carotid and vertebral arteries were evaluated for the presence of fibromuscular dysplasia, dissection and/or pseudoaneurysm, ectasia and/or aneurysmal dilation, atherosclerosis, and webs. Carotid tortuosity was categorized into kinks, loops, coils, and retrojugular and/or retropharyngeal carotid courses; vertebral tortuosity was classified by subjective analysis of severity.RESULTS: Two hundred fourteen patients were included in the final cohort, of whom 205 (95.8%) were women; the average age was 54.4 years. Fibromuscular dysplasia was the most frequently observed abnormality (83 patients; 38.8%), followed by dissections and/or pseudoaneurysms (n ¼ 28; 13.1%), ectasia and/or aneurysmal dilation (n ¼ 22; 10.3%), and carotid webs (n ¼ 10; 4.7%). At least 1 type of carotid tortuosity was present in 99 patients (46.3%). The majority (n ¼ 185; 86.4%) of patients had no carotid atherosclerosis; and 26 (12.2%) had mild; 3 (1.4%), moderate; and 0, severe carotid atherosclerosis. CONCLUSIONS:The most common abnormality in the cervical artery vasculature of patients with spontaneous coronary artery dissection is fibromuscular dysplasia. Cervical dissections were higher than previously reported but were not observed in most patients. ABBREVIATIONS: ACS ¼ acute coronary syndrome; CTD ¼ connective tissue disorder; FMD ¼ fibromuscular dysplasia; SCAD ¼ spontaneous coronary artery dissection S pontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS), predominantly affecting otherwise healthy young and middleaged women. 1,2 By definition, it refers to dissection of the coronary artery wall in the absence of trauma, atherosclerosis, or iatrogenic causes. 3 The resultant intramural hematoma and/or intimal flap can cause substantial luminal narrowing, leading to myocardial ischemia and infarction. Once considered rare, SCAD is now thought to be the cause of up to 4% of cases of ACS and up to 35% of cases of ACS in women younger than of 50 years of age. 4,5 Furthermore, there is evidence that the incidence of SCAD has increased during the past decades. 6

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Lack of Association of Spontaneous Coronary Artery Dissection With Autoimmune Disease

Cited by 33 publications

References 62 publications

Vascular histopathology and connective tissue ultrastructure in spontaneous coronary artery dissection: pathophysiological and clinical implications

Vascular histopathology and connective tissue ultrastructure in spontaneous coronary artery dissection: pathophysiological and clinical implications

Association Between Autoimmune Diseases and Spontaneous Cervicocranial Arterial Dissection

Prevalence of Cervical Artery Abnormalities on CTA in Patients with Spontaneous Coronary Artery Dissection: Fibromuscular Dysplasia, Dissection, Aneurysm, and Tortuosity

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