Spontaneous Coronary Artery Dissection: Latest Developments and New Frontiers

Yang, Cathevine; Alfadhel, Mesfer; Saw, Jacqueline

doi:10.1007/s11883-020-00866-4

Cited by 25 publications

(49 citation statements)

References 42 publications

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“…Therefore, current diagnosis and treatment are important. Its etiologies mainly include fibromuscular dysplasia (FMD), estrogen fluctuation periods such as pregnancy, connective tissue disease, and autoimmune diseases ( 4 ), such as systemic lupus erythematosus, which was the case in our patient here. SLE is an independent risk factor for cardiovascular disease ( 5 ), and cardiovascular disease has become the most common cause of death in SLE patients at late stage, especially atherosclerosis ( 6 ).…”

Section: Introductionmentioning

confidence: 71%

“…SCAD is an uncommon cause of myocardial infarction and sudden cardiac death, and it frequently occurs in young, female patients without cardiovascular disease risk factors ( 4 ). SCAD is a nonatherosclerotic disease ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…The goal of treatment is to reduce the patient's symptoms and prevent recurrence ( 4 ). Conservative treatment is the mainstay of SCAD and most patients can heal completely over time ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacological treatments, such as antiplatelet agents, β-blockers, angiotensin-converting enzyme inhibitors, and statins, are preferred when the patient's symptoms do not progress and hemodynamics are stable ( 3 , 9 ). β-blockers have been shown advantages in reducing recurrent SCAD, but evidence is still lacking ( 4 ). Thrombolysis is contraindicated for SCAD because it may be effective to dissolve the thrombus in the false lumen ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous coronary artery dissection and atherosclerosis in a young man with systemic lupus erythematosus: A case report and literature review

Huang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundSpontaneous coronary artery dissection (SCAD) is a rare coronary artery disease that frequently occurs in young, female patients without risk factors, and conservative treatment is often recommended for its management. The patient reported here is a male patient with systemic lupus erythematosus (SLE).Case summaryWe described a 28-year-old man with SLE who presented with acute ST-segment elevation myocardial infarction (STEMI), and was diagnosed with SCAD through a long dissection of the left anterior descending branch (LAD) by coronary angiography. The patient was treated with percutaneous coronary intervention (PCI) with stent implantation. Ten years later, he developed in-stent stenosis and other coronary atherosclerosis and was retreated with PCIs. Based on this case and according to the literature review, the existing treatment and prognosis of SLE with spontaneous coronary artery dissection and atherosclerosis are discussed.ConclusionCardiovascular complications should be considered in patients with systemic lupus erythematosus, although they may not initially be atherosclerotic diseases. Attention should be paid to distinguish spontaneous coronary dissection in order to minimize missed or delayed diagnoses and take appropriate managements, as well as the development of atherosclerosis in SLE patients, and timely intervention has a better prognosis.

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Section: Introductionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Spontaneous coronary artery dissection and atherosclerosis in a young man with systemic lupus erythematosus: A case report and literature review

Huang

et al. 2022

Front. Cardiovasc. Med.

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“…Management is decided by risk stratification. Those having left main dissection, persistent or recurrent ischemic, ventricular tachycardia, cardiogenic shock and mechanical complication like mitral regurgitation are labelled as high risk [9] in this subgroup of patients, revascularization by either coronary artery bypass (CABG) or PCI is deemed appropriate [10]. PCI for SCAD is associated with less success rate (46%) and increased complication.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2021

Int J Clin Cardiol

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Spontaneous coronary artery dissection (SCAD) is a rare but an important cause of ST elevation myocardial infarction (STE-MI) in young patients. Here, we report case of a 32-year-old male presenting as acute anterior wall STEMI for which was thrombolysed. Coronary angiogram revealed spiral luminal filling defects with extensive contrast staining of proximal left anterior descending artery involving diagonal branch representing Type D dissection. As patient refused any intervention, he was managed conservatively. He presented with unstable angina 6-weeks later. Repeat angiogram revealed complete healing of dissection along with borderline lesion. As his treadmill test was negative for exercise induced myocardial ischaemia, he was managed conservatively. This case highlights that beside intervention, patients with high grade dissection may respond to conservative management.

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Incidence and outcomes of cardiogenic shock among women with spontaneous coronary artery dissection

Osman

Syed

Simpson

et al. 2022

Cathet Cardio Intervent

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Background: There is a paucity of data on cardiogenic shock (CS) incidence and outcomes among patients with spontaneous coronary artery dissection (SCAD).Methods: Women admitted to the hospital for acute myocardial infarction (AMI) with and without SCAD were identified from the United States National Readmission Database from October 1, 2015 to December 31, 2018. We calculated the incidence of CS among women with AMI with and without SCAD and odds for developing CS after adjusting for baseline characteristics. In addition, we report the utilization of percutaneous coronary intervention, mechanical circulatory support, severe disability surrogates, and 30-day readmission rates. Results: A total of 664,292 patients admitted for AMI were eligible for analysis, including 6643 patients with SCAD and 657,649 without SCAD. Patients with SCAD were younger (57 years [interquartile range, IQR 48-68] vs. 71 years [IQR 60-81],p < 0.01) and had fewer comorbidities yet had a higher incidence of CS as compared to patients without SCAD (9% vs. 5%, p < 0.01) and remained at elevated risk after adjusting for baseline comorbidities (adjusted odds ratio 1.5 [95% confidence interval, CI 1.2-1.7]). Among patients who developed CS, those with SCAD had lower in-hospital mortality than non-SCAD (31% vs. 39%, p < 0.01), and were more likely to receive mechanical circulatory support. Conclusions:In a nationally representative sample of women admitted for AMI, we found that patients with SCAD had a higher risk of developing CS and required more frequent use of mechanical circulatory support but were more likely to survive to discharge than women suffering AMI from causes other than SCAD.

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Spontaneous Coronary Artery Dissection: Latest Developments and New Frontiers

Cited by 25 publications

References 42 publications

Spontaneous coronary artery dissection and atherosclerosis in a young man with systemic lupus erythematosus: A case report and literature review

Spontaneous coronary artery dissection and atherosclerosis in a young man with systemic lupus erythematosus: A case report and literature review

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Incidence and outcomes of cardiogenic shock among women with spontaneous coronary artery dissection

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