Spontaneous coronary artery dissection: Role of prognostic markers and relationship with genetic analysis

Antonutti, Marco; Baldan, Federica; Lanera, Corrado; Spedicato, Leonardo; Zanuttini, Davide; Bisceglia, Teodoro; Favaretto, Enrico; Poli, Stefano; Tioni, Chiara; Sut, Dario; Gregori, Darío; Damante, Giuseppe; Proclemer, Alessandro

doi:10.1016/j.ijcard.2020.10.040

Cited by 10 publications

(16 citation statements)

References 28 publications

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“…There was no significant association between ventricular arrhythmias at presentation and SCAD recurrence. Contrary to this, a retrospective cohort study of 70 SCAD patients showed that ventricular arrhythmia at index event was associated with an elevated risk of recurrent SCAD [21]. Notably, another observational study showed that patients presenting with cardiac arrest at index SCAD event tended to experience recurrence more commonly than patients without cardiac arrest [28].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with recurrent spontaneous coronary artery dissection: a systematic review and meta-analysis

Chi

Najafi

Montazerin

et al. 2022

Coronary Artery Disease

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BackgroundThe risk of recurrent spontaneous coronary artery dissection (SCAD) is a major concern to SCAD patients and clinicians. Identifying the high-risk subsets of recurrent SCAD remains an ongoing challenge. The meta-analysis aimed to assess the potential predictors for SCAD recurrence. Methods A literature search was performed in PubMed to collect studies that assessed potential factors associated with recurrence of SCAD among angiographically confirmed SCAD patients, including pregnancy, ventricular arrhythmia at presentation, history of hypertension, migraine, fibromuscular dysplasia (FMD), extracoronary vascular abnormalities (EVA), recent emotional or physical stress, and use of thienopyridine, beta-blocker, or statin. A meta-analytic approach was employed to estimate the relative risk (RR) with a 95% confidence interval (CI) by fitting random-effects models using the generic inverse variance weighted method. ResultsA total of 14 studies representing 4206 SCAD patients were included. Hypertension (RR, 1.49; 95% CI, 1.05-2.12; P = 0.0247) and FMD (RR, 2.02; 95% CI, 1.03-3.94; P = 0.0404) were associated with a greater risk of SCAD recurrence. The use of beta-blocker (RR, 0.51; 95% CI, 0.33-0.77; P = 0.0013) was associated with a lower risk of SCAD recurrence. Pregnancy, ventricular arrhythmia at presentation, migraine, EVA, recent emotional or physical stress, and use of thienopyridine or statin were not significantly associated with recurrent SCAD (P > 0.05).Conclusion SCAD patients with hypertension or FMD were at a higher risk of recurrence, whereas beta-blocker usage was related to a reduced risk. These findings may provide insights into risk prediction and management after the SCAD episode.

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Section: Discussionmentioning

confidence: 99%

Factors associated with recurrent spontaneous coronary artery dissection: a systematic review and meta-analysis

Chi

Najafi

Montazerin

et al. 2022

Coronary Artery Disease

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“…Shah, et al found that the prevalence of SCAD is between 0.1-1.1% [15,16]. In addition, Antonutti, et al found that SCAD accounts for 0.5% of sudden cardiac deaths [17].…”

Section: Discussionmentioning

confidence: 99%

Acute Management of a Spontaneous Coronary Artery Dissection with a Distal Occlusive Thrombus

Trinava¹,

Jason²,

Brown³

et al. 2022

Int J Clin Cardiol

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Background: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (MI) and sudden cardiac death (SCD). SCAD is mostly described in young females with a sparse cardiac history. The pathophysiology of SCAD has not been clearly elucidated in the literature and the underlying etiology continues to be investigated. Case presentation:We describe a unique case of a 57-year-old female who presented with chest pain who was found to have a ST segment elevation myocardial infarction (STEMI) on electrocardiogram. Cardiac coronary angiography demonstrated SCAD of the mid to distal left anterior descending (LAD) artery who was originally treated with, but ultimately failed, medical management. Less than 24 hours after presentation, she had a ventricular fibrillation cardiac arrest with repeat coronary angiography indicating complete occlusion of her mid to distal LAD, resulting in management with coronary artery bypass grafting (CABG). Conclusion:Conservative management of SCAD should be attempted with patients however LAD lesions are at high risk for cardiac decompensation, requiring invasive revascularization with PCI or CABG.

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“…Genetic studies have shown the association of the SCAD with the PHACTR1/EDN1 locus. Antonutti et al described gene mutations in COL3A1, COL5A2, FBN2, LTBP2, NOTCH1 and ELN genes and their association with major adverse cardiovascular events including recurrent SCAD, cardiogenic shock and heart failure [10]. These gene mutations are associated with proximal SCAD and absence of these gene mutations are associated with more distal artery involvement [10].…”

Section: Discussionmentioning

confidence: 99%

The Young Heart Tears Easily Apart: A Case Report of Spontaneous Coronary Artery Dissection

Ravipati¹,

Rodrigues²,

Rao³

et al. 2021

Cureus

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Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), seen mostly in young females. The rarity and limited knowledge of the disease make its management challenging. Prompt diagnosis of the condition is extremely important to decrease both long-and short-term complications. Treatment options depend on hemodynamic stability and the location of the dissection-with more distal lesions treated more conservatively as opposed to proximal lesions which are treated with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The following are the two cases with different presentation, management and outcomes.Our first patient was a 35-year-old woman with no medical history who presented with acute, anginal pain, diaphoresis and palpitations. She was hemodynamically stable on presentation, with work-up significant for electrocardiogram (ECG) with sinus bradycardia, ST elevation in leads V1-V6, and elevated troponin level of 4 ng/ml. There was no evidence of a pulmonary embolism on computed tomography (CT) of the chest. A coronary angiogram showed 100% dissection of the proximal to mid-left anterior descending (LAD) artery. Attempts to place a stent in the proximal to mid LAD were unsuccessful as the true lumen of the LAD was not accessible. The patient became hemodynamically unstable, and an emergent CABG was done, restoring blood flow. The patient recovered during her hospital stay and was discharged with dual antiplatelet therapy (DAPT), beta-blockers, and atorvastatin.The second patient was a 28-year-old woman, with a history of hypertension who presented with anginal chest pain. Workup showed ECG with minimal ST elevations in anteroseptal leads, with elevated troponin level to 0.71 ng/ml. Coronary angiogram showed 40-50% stenosis of the mid LAD with an aneurysmal segment. An echocardiogram showed no evidence of wall motion abnormalities, and she had a normal left ventricular ejection fraction (LVEF). She was discharged home the next day, on medical management. After two days, she returned to the hospital with similar complaints, with work-up significant for ECG with nonspecific ST-T abnormality, and troponin level which peaked at 2.22 ng/ml. She was started on a heparin drip, and a repeat left heart catheterization revealed type 2 dissection of the mid to distal LAD, with intravascular ultrasound showing a fractional flow reserve of 0.76. She was discharged home on DAPT, beta-blocker, calcium channel blocker (CCB), and atorvastatin, with close cardiology follow up. These two cases highlight the importance of keeping in mind the possibility of SCAD, especially when relatively healthy young women present with anginal symptoms. Early diagnosis of the condition and prompt management are extremely important to ensure favourable outcomes. The two cases also describe the coronary angiogram findings in SCAD, and the different strategies employed in the management of this condition.

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Spontaneous coronary artery dissection: Role of prognostic markers and relationship with genetic analysis

Cited by 10 publications

References 28 publications

Factors associated with recurrent spontaneous coronary artery dissection: a systematic review and meta-analysis

Factors associated with recurrent spontaneous coronary artery dissection: a systematic review and meta-analysis

Acute Management of a Spontaneous Coronary Artery Dissection with a Distal Occlusive Thrombus

The Young Heart Tears Easily Apart: A Case Report of Spontaneous Coronary Artery Dissection

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