Management and outcome of spontaneous coronary artery dissection: Conservative therapy versus revascularization

Buja, Paolo; Coccato, Micol; Fraccaro, Chiara; Tarantini, Giuseppe; Isabella, Giambattista; Almamary, Ahmed; Dariol, Gilberto; Panfili, Marco; Iliceto, Sabino; Napodano, Massimo

doi:10.1016/j.ijcard.2013.03.116

Cited by 27 publications

(19 citation statements)

References 8 publications

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“…However, major limitations of this study were selection bias, publication bias, and nonuniform follow-up inherent with data being primarily compiled from published case reports. Although a recent single-center study also suggested favorable outcomes for PCI in SCAD, 10 our earlier observations suggested poor outcomes with PCI. 4 The current study addressed limitations of previous SCAD analyses by including a larger sample size and incorporating stratification by baseline vessel flow at presentation.…”

Section: Discussionmentioning

confidence: 52%

“…Clinicians confronted with decision making on the acute management of SCAD face conflicting data 4,[8][9][10] and as such treatment continues to be empirical. Some have suggested favorable outcomes with invasive management.…”

mentioning

confidence: 99%

“…Some have suggested favorable outcomes with invasive management. 9,10 However, other small SCAD series have shown that in selected patients, conservative management can be associated with late angiographic healing of dissection. 4,8,11 More so, we previously observed an unexpected elevated risk of technical complications in patients with SCAD treated acutely with percutaneous coronary intervention (PCI).…”

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confidence: 99%

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Spontaneous Coronary Artery Dissection

Eleid

Best

et al. 2014

Circ: Cardiovascular Interventions

508

277

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Background-Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic acute coronary syndrome for which optimal management remains undefined. Methods and Results-We performed a retrospective study of 189 patients presenting with a first SCAD episode. We evaluated outcomes according to initial management: (1) revascularization versus conservative therapy and (2) percutaneous coronary intervention (PCI) versus conservative therapy stratified by vessel flow at presentation. Demographics were similar in revascularization versus conservative (mean age, 44±9 years; women 92% both groups), but vessel occlusion was more frequent in revascularization (44/95 versus 18/94). There was 1 in-hospital death (revascularization) and 1 late death (conservative). Procedural failure rate was 53% in those managed with PCI. In the subgroup of patients presenting with preserved vessel flow, rates of PCI failure were similarly high (50%), and 6 (13%) required emergency coronary artery bypass grafting. In the conservative group, 85 of 94 (90%) had an uneventful in-hospital course, but 9 (10%) experienced early SCAD progression requiring revascularization.

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Section: Discussionmentioning

confidence: 52%

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confidence: 99%

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confidence: 99%

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Spontaneous Coronary Artery Dissection

Eleid

Best

et al. 2014

Circ: Cardiovascular Interventions

508

277

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“…Because the prognosis of SCAD is thought to be favorable if patients could survive the acute phase [5], cardiologists are focusing on how to manage acute-phase SCAD. The primary clinical presentation of SCAD is flow-limiting ACS [2,4,11,18,19]. In our study, 92% of SCAD patients presented STEMI.…”

Section: Discussionmentioning

confidence: 49%

Prognosis of spontaneous coronary artery dissection treated by percutaneous coronary intervention with optical coherence tomography

Nishiguchi

Tanaka

Taruya

et al. 2017

Journal of Cardiology

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“…Optimal management for patients presenting with SCAD is uncertain and should be individualized based on the severity of the clinical presentation and the coronary anatomy by angiography [2,3]. Observationally, percutaneous revascularization in SCAD has been associated with technical failure [1].…”

Section: Diagnosismentioning

confidence: 99%