Spontaneous Coronary Artery Dissection and Cardiogenic Shock

Yang, Cathevine; Inohara, Taku; Alfadhel, Mesfer; McAlister, Cameron; Starovoytov, Andrew; Choi, Dexter; Mancini, G.B. John; Aymong, Eve; Saw, Jacqueline

doi:10.1016/j.jacc.2021.01.048

Cited by 4 publications

(6 citation statements)

References 4 publications

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“…The present study is among the largest to evaluate real-world clinical experience of SCAD with comparative evaluation of those with SCAD-CS in both men and women of all ages. In this NRD study, 11% of identified SCAD hospitalizations had cardiogenic shock, which is considerably higher than previous estimates of 2–6% with SCAD-shock [ 7 , 8 ]. Additionally, SCAD-CS patients were older, less likely to be female, and had higher prevalence of comorbid hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), or existing atherosclerotic cardiovascular disease, a departure from previous findings [ 8 , 9 ].…”

Section: Discussioncontrasting

confidence: 68%

“…In this NRD study, 11% of identified SCAD hospitalizations had cardiogenic shock, which is considerably higher than previous estimates of 2–6% with SCAD-shock [ 7 , 8 ]. Additionally, SCAD-CS patients were older, less likely to be female, and had higher prevalence of comorbid hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), or existing atherosclerotic cardiovascular disease, a departure from previous findings [ 8 , 9 ]. Mortality for SCAD-CS was high in our study, as has been described previously with in-hospital mortality rates between 8–30% [ 8 , 9 ].…”

Section: Discussioncontrasting

confidence: 68%

“…Additionally, SCAD-CS patients were older, less likely to be female, and had higher prevalence of comorbid hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), or existing atherosclerotic cardiovascular disease, a departure from previous findings [ 8 , 9 ]. Mortality for SCAD-CS was high in our study, as has been described previously with in-hospital mortality rates between 8–30% [ 8 , 9 ]. Nonetheless, SCAD-CS mortality is likely lower than atherosclerotic MI-related CS [ 10 ].…”

Section: Discussionmentioning

confidence: 83%

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Spontaneous Coronary Artery Dissection with Cardiogenic Shock in the United States

Krittanawong,

Bandyopadhyay,

Patel

et al. 2024

Rev. Cardiovasc. Med.

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Background: Spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic separation of the epicardial coronary artery walls that creates a false lumen. SCAD poses a difficult challenge in management, as decisions regarding revascularization and medical management seem to be tailored to the individual patient. We evaluated and compared outcomes based on cardiogenic shock in patients with SCAD utilizing Nationwide Readmissions Database (NRD) between January 1, 2016, to December 30, 2020. Methods: We utilized the NRD 2016–2019 to carry out this study. We evaluated demographics (e.g., age, gender), conventional risk factors, comorbidities present on the index admission, and in-hospital outcomes using their specific ICD-10-CM codes. The primary outcomes were In-hospital mortality and 30-day readmission, and the secondary outcome was to compare the complications in SCAD patient with cardiogenic shock (CS) compared to those without CS. Results: We analyzed 2473 individuals with SCAD, 2199 of these individuals did not have cardiogenic shock whereas 274 of these individuals did have cardiogenic shock. When comparing SCAD with cardiogenic shock to SCAD without cardiogenic shock, there was a statistically significant increased odds ratio (OR) for death (propensity matched OR 24.93 (7.49–83.05), use of mechanical circulatory support (propensity matched OR 15.30 (6.87–34.04), ventricular tachycardia (propensity matched OR 4.45 (1.92–10.34), utilization of blood transfusions (propensity matched OR 3.82 (1.86–7.87), acute kidney injury (propensity matched OR 4.02 (1.45–11.13), need for mechanical ventilation (propensity matched OR 8.87 (3.53–22.31), and respiratory failure (propensity matched OR 4.95 (1.83–13.41)))))))). There was no statistically significant difference in 30-day readmission rates between the two groups. Conclusions: SCAD is a unique condition that can lead to many complications. In our analysis, we showed that SCAD associated with cardiogenic shock compared to SCAD not associated with cardiogenic shock results in greater odds of complications including death, use of mechanical circulatory support, need for blood transfusions, ventricular tachycardia, acute kidney injury, use of mechanical ventilation, and respiratory failure. SCAD with cardiogenic shock represents a significantly critical clinical scenario that requires a multi-disciplinary approach to prevent the many potential complications associated with this disease process.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 83%

See 1 more Smart Citation

Spontaneous Coronary Artery Dissection with Cardiogenic Shock in the United States

Krittanawong,

Bandyopadhyay,

Patel

et al. 2024

Rev. Cardiovasc. Med.

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show abstract

“…The incidence of CS in SCAD is reported to be between 1.2% and 15.9%. 2 , 5 , 8 , 11 , 48 , 49 , 50 , 51 , 52 In the Canadian SCAD registry, analysis of a prospective cohort of 1056 patients found the incidence of CS to be 2.3%. 52 Patients with CS were significantly younger, and they were more likely to have connective tissue disorder and grand multiparity, and to be peripartum.…”

Section: What Is New In the Prognosis And Acute Management Of Scad?mentioning

confidence: 99%

“… 2 , 5 , 8 , 11 , 48 , 49 , 50 , 51 , 52 In the Canadian SCAD registry, analysis of a prospective cohort of 1056 patients found the incidence of CS to be 2.3%. 52 Patients with CS were significantly younger, and they were more likely to have connective tissue disorder and grand multiparity, and to be peripartum. In this cohort, 75% required mechanical circulatory support, most commonly with an intra-aortic balloon pump.…”

Section: What Is New In the Prognosis And Acute Management Of Scad?mentioning

confidence: 99%