National French registry of spontaneous coronary artery dissections: prevalence of fibromuscular dysplasia and genetic analyses

Combaret, Nicolas; Gerbaud, Édouard; Dérimay, François; Souteyrand, Géraud; Cassagnes, L.; Bouajila, Sara; Berrandou, Takiy-Eddine; Rangé, Gregoire; Méneveau, Nicolas; Harbaoui, Brahim; Lattuca, Benoît; Bouatia-Naji, Nabila; Motreff, Pascal

doi:10.4244/eij-d-20-01046

Cited by 34 publications

(21 citation statements)

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“…This study supports the presence of genetic overlap between risk of SCAD and other vascular diseases, involving generally younger individuals and more women such as cervical arterial dissection, migraine, subarachnoid haemorrhage and FMD. These conditions are reported to occur at increased frequency in SCAD patients, 10-13 supporting shared causal biological mechanisms. Among the genes we prioritize as novel SCAD loci, we highlight the ATPase plasma membrane Ca2+ transporting 1 gene ( ATP2B1 ) that we have recently reported to associate with FMD, 32 a well-established locus for blood pressure risk 33 via its role in VSMCs intracellular calcium homeostasis and blood pressure regulation.…”

Section: Discussionmentioning

confidence: 94%

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Genome-wide association meta-analysis of spontaneous coronary artery dissection reveals common variants and genes related to artery integrity and tissue-mediated coagulation

Adlam

Berrandou

Georges

et al. 2022

Preprint

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Spontaneous coronary artery dissection (SCAD) is an understudied cause of acute myocardial infarction primarily affecting women. It is not known to what extent SCAD is genetically distinct from other cardiovascular diseases, including atherosclerotic coronary artery disease (CAD). Through a meta-analysis of genome-wide association studies including 1917 cases and 9292 controls of European ancestry, we identified 17 risk loci, including 12 new, with odds ratios ranging from 2.04 (95%CI 1.77-2.35) on chr21 to 1.25 (95%CI 1.16-1.35) on chr4. A locus on chr1 containing the tissue factor gene (F3), which is involved in blood coagulation cascade, appears to be specific for SCAD risk. Prioritized genes were mainly expressed in vascular smooth muscle cells and fibroblasts of arteries and are implicated predominantly in extracellular matrix biology (e.g. COL4A1/A2, HTRA1 and TIMP3). We found that several variants associated with SCAD had diametrically opposite associations with CAD suggesting that shared biological processes contribute to both diseases but through different mechanisms. We also demonstrated an inferred causal role for high blood pressure, but not other CAD risk factors, in SCAD. Our findings provide novel pathophysiological insights involving arterial integrity and tissue-mediated coagulation in SCAD and set the stage for future specific therapeutics and prevention for this disease.

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Section: Discussionmentioning

confidence: 94%

“…8 SCAD has been clinically associated with migraine 9 and extra-coronary arteriopathies including fibromuscular dysplasia (FMD). 10-13 However, co-existent coronary atherosclerosis is uncommon. 8,14 Whilst the genetic basis of CAD is increasingly well established, 15 the pathophysiology of SCAD remains poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Genome-wide association meta-analysis of spontaneous coronary artery dissection reveals common variants and genes related to artery integrity and tissue-mediated coagulation

Adlam

Berrandou

Georges

et al. 2022

Preprint

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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%

“…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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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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“…However, the demographic and SCAD-related characteristics in our series are in line with those reported in other large SCAD cohorts. 7,21,28 Second, the comparison of the prevalence of multivessel FMD, aneurysms, and dissections with that reported in registries focused on patients with primary FMD [16][17][18][19] needs to be considered with caution. Indeed, in the latter, with the exception of the Assessment of Renal and Cervical Artery Dysplasia study, 16 whole body scanning was not performed in all patients.…”

Section: Limitationsmentioning

confidence: 99%

Prevalence and Disease Spectrum of Extracoronary Arterial Abnormalities in Spontaneous Coronary Artery Dissection

et al. 2022

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Key Points Question What is the prevalence of fibromuscular dysplasia, aneurysms, dissection, and tortuosity in extracoronary arteries of patients who developed a spontaneous coronary artery dissection (SCAD)? Findings In this case series including 173 patients with SCAD, using magnetic resonance angiography with blinded interpretation of the findings, 32% of the patients had fibromuscular dysplasia, 8% had aneurysms, and 2% had dissections; the prevalence of arterial tortuosity was similar in cases and controls. Extracoronary vascular events over a median 5-year follow-up were rare. Meaning The findings of this blinded analysis suggest that, in patients with SCAD, severe multivessel fibromuscular dysplasia, aneurysms, and dissections are infrequent and seldom associated with clinically evident vascular events.

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National French registry of spontaneous coronary artery dissections: prevalence of fibromuscular dysplasia and genetic analyses

Cited by 34 publications

References 20 publications

Genome-wide association meta-analysis of spontaneous coronary artery dissection reveals common variants and genes related to artery integrity and tissue-mediated coagulation

Genome-wide association meta-analysis of spontaneous coronary artery dissection reveals common variants and genes related to artery integrity and tissue-mediated coagulation

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

Prevalence and Disease Spectrum of Extracoronary Arterial Abnormalities in Spontaneous Coronary Artery Dissection

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