Abstract:Myocardial infarction with nonobstructive coronary artery disease due to spontaneous coronary artery dissection (SCAD) accounts for 5–8% of acute coronary syndrome (ACS) presentations. The demographic characteristics, risk factors, and management of patients with SCAD differ from those with atherosclerotic disease. The objective of this review is to provide a contemporary understanding of the epidemiology, pathophysiology, clinical presentation, and management of SCAD.
“…Additionally, some patients had arrhythmias, cardiogenic shock, cardiac tamponade, and cardiac arrest. These presentations were also reported in previous studies [127].…”
Section: Discussionsupporting
confidence: 88%
“…Therefore, this raises the question of whether this is either a bias of smaller case reports/series or whether patients with a predisposing psychosocial trigger have a slightly more severe phenotype at presentation. Studies have revealed that performing PCI in SCAD patients is challenging, and its success rate is lower than that of PCI in atherosclerotic disease [9,127].…”
Background
Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, particularly in younger women. Due to limited information about SCAD, case reports and case series can provide valuable insights into its features and management. This study aimed to comprehensively evaluate the features of SCAD patients who experienced psychophysical stress before the SCAD event.
Methods
We conducted an electronic search of PubMed, Scopus, and Web of Science from inception until January 7, 2023. We included case reports or series that described patients with SCAD who had experienced psychophysical stress before SCAD. Patients with pregnancy-associated SCAD were excluded from our analysis.
Results
In total, we included 93 case reports or series describing 105 patients with SCAD. The average patient age was 44.29 ± 13.05 years and a total of 44 (41.9%) of patients were male. Among the included SCAD patients the most prevalent comorbidities were fibromuscular dysplasia (FMD) and hypertension with the prevalence of 36.4 and 21.9%, respectively. Preceding physical stress was more frequently reported in men than in women; 38 out of 44 (86.4%) men reported physical stress, while 36 out of 61 (59.1%) females reported physical stress (p value = 0.009). On the other hand, the opposite was true for emotional stress (men: 6 (13.6%)), women: 29 (47.6%), p value < 0.001). Coronary angiography was the main diagnostic tool. The most frequently involved artery was the left anterior descending (LAD) (62.9%). In our study, recurrence of SCAD due to either the progression of a previous lesion or new SCAD in another coronary location occurred more frequently in those treated conservatively, however the observed difference was not statistically significant (p value = 0.138).
Conclusion
While physical stress seems to precede SCAD in most cases, emotional stress is implicated in females more than males.
“…Additionally, some patients had arrhythmias, cardiogenic shock, cardiac tamponade, and cardiac arrest. These presentations were also reported in previous studies [127].…”
Section: Discussionsupporting
confidence: 88%
“…Therefore, this raises the question of whether this is either a bias of smaller case reports/series or whether patients with a predisposing psychosocial trigger have a slightly more severe phenotype at presentation. Studies have revealed that performing PCI in SCAD patients is challenging, and its success rate is lower than that of PCI in atherosclerotic disease [9,127].…”
Background
Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, particularly in younger women. Due to limited information about SCAD, case reports and case series can provide valuable insights into its features and management. This study aimed to comprehensively evaluate the features of SCAD patients who experienced psychophysical stress before the SCAD event.
Methods
We conducted an electronic search of PubMed, Scopus, and Web of Science from inception until January 7, 2023. We included case reports or series that described patients with SCAD who had experienced psychophysical stress before SCAD. Patients with pregnancy-associated SCAD were excluded from our analysis.
Results
In total, we included 93 case reports or series describing 105 patients with SCAD. The average patient age was 44.29 ± 13.05 years and a total of 44 (41.9%) of patients were male. Among the included SCAD patients the most prevalent comorbidities were fibromuscular dysplasia (FMD) and hypertension with the prevalence of 36.4 and 21.9%, respectively. Preceding physical stress was more frequently reported in men than in women; 38 out of 44 (86.4%) men reported physical stress, while 36 out of 61 (59.1%) females reported physical stress (p value = 0.009). On the other hand, the opposite was true for emotional stress (men: 6 (13.6%)), women: 29 (47.6%), p value < 0.001). Coronary angiography was the main diagnostic tool. The most frequently involved artery was the left anterior descending (LAD) (62.9%). In our study, recurrence of SCAD due to either the progression of a previous lesion or new SCAD in another coronary location occurred more frequently in those treated conservatively, however the observed difference was not statistically significant (p value = 0.138).
Conclusion
While physical stress seems to precede SCAD in most cases, emotional stress is implicated in females more than males.
“…Intravascular ultrasound was not performed, but angiographic findings in combination with patient characteristics are thought to fit best with type 3 spontaneous coronary artery dissection (SCAD). 1 Computed tomography angiography of the head, chest, abdomen, and pelvis were without evidence of aneurysms elsewhere. Figure 1 Electrocardiogram on Admission Electrocardiogram was remarkable for ST-segment elevations in II, III, aVF, and V 3 to V 6 —consistent with inferior and anterior ischemia.…”
“…Se debe considerar la limitación que se atribuye a la radiación en pacientes jóvenes y en el embarazo. La resolución espacial de la TC es subóptima para los vasos pequeños, lo que genera falsos negativos, y además las placas ateroscleróticas blandas pueden confundirse con un hematoma intramural 179 .…”
Section: Pregunta 5 ¿Qué Rol Tiene La Tc En El Seguimiento De Los Pac...unclassified
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