Systematic review and meta-analysis of the clinical characteristics and outcomes of spontanous coronary artery dissection

Franke, Kyle B.; Nerlekar, Nitesh; Marshall, Henry; Psaltis, Peter J.

doi:10.1016/j.ijcard.2020.08.076

Cited by 15 publications

(16 citation statements)

References 24 publications

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“… 20–22 An older study of 32 869 patients from 3 centres in western Denmark identified a SCAD prevalence of 0.2% during 8 years whereas a Japanese study of 20 195 MI patients collected in 20 centres during 13 years identified a SCAD prevalence of 0.31%. 20–22 Our results are in concordance with the recently published meta-analysis by Franke et al 23 including more than 2000 patients. In addition, we did not exclude patients with angiographic signs of atherosclerosis in other than SCAD vessels.…”

Section: Discussionsupporting

confidence: 91%

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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Section: Discussionsupporting

confidence: 91%

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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“…Although the inhospital outcomes reported by Garcia-Guimaraes et al 5 are confirmatory, if not better than those reported by others,3 the MAEs and MACCEs reported did not include the considerable psychosocial burden associated with SCAD, including insomnia, anxiety, depression and even post-traumatic stress disorder,6 stemming from the lack of precise knowledge of disease pathophysiology and the considerable concerns experience by many SCAD sufferers of the possibility of recurrences. Of interest in this regard, Garcia-Guimaraes and colleagues5 reported a SCAD recurrence rate of only 2% over a median follow-up of over 2 years, which is markedly lower than the 17% over a median follow-up of 3.9 years and 29.4% over 10 years reported by the Mayo Clinic Group,7 and 22% reported by Nakashima et al 8 over a median follow-up of 2.8 years.…”

mentioning

confidence: 82%

“…Spontaneous coronary artery dissection (SCAD) is an infrequent but increasingly recognised cause of acute coronary syndrome (ACS) that predominantly affects relatively young women aged 45–52 years and may even occur in association with pregnancy, where it is the most common cause of a myocardial infarction 1 2. In contrast to ACS due to atherosclerotic disease, SCAD sufferers have few traditional risk factors apart from hypertension,3 and the pathophysiology involves impaired coronary flow, not due to plaque rupture, plaque erosion or thrombus formation associated with a calcific nodule, as is the case for atherosclerotic disease,4 but to the spontaneous formation of an intramural haematoma (IMH) that causes dissection of the vessel wall medial layer. The IHM is likely due to vasa vasorum rupture with or without an intimal tear.…”

mentioning

confidence: 99%

Adverse events after spontaneous coronary artery dissection

Graham

2022

Heart

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“…Interestingly, females who accounted for the remaining 43% were significantly younger with an average age of 42.5 years, compared to 47.5 years for male patients (223). It is unclear to what extent referral bias contributed to this divergence in patient populations, however, this follows the same trend of age-based gender risk observed in aortic dissection and SCAD (109,161). A history of a cerebral aneurysm has been reported in almost 1 in 5 CeAD patients (18.2%), suggesting a common genetic risk (224).…”

Section: Cervical Artery Dissection Associated Conditions and Risk Fa...mentioning

confidence: 94%

“…Sexual dimorphism is less apparent in PA dissections, with a slight tendency to occur more frequently in males than females (ratio 1.1:1). However, as with the aforementioned arterial dissection types, cases diverge with both age and gender (109,161,223) where males represented 76% of cases in the age group 21-30, while females represented 70% of cases in the age group 41-50 (Figure 5).…”

Section: Pulmonary Artery Dissectionsmentioning

confidence: 97%

Arterial dissections: Common features and new perspectives

Bax

Romanov

Junday

et al. 2022

Front. Cardiovasc. Med.

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Arterial dissections, which involve an abrupt tear in the wall of a major artery resulting in the intramural accumulation of blood, are a family of catastrophic disorders causing major, potentially fatal sequelae. Involving diverse vascular beds, including the aorta or coronary, cervical, pulmonary, and visceral arteries, each type of dissection is devastating in its own way. Traditionally they have been studied in isolation, rather than collectively, owing largely to the distinct clinical consequences of dissections in different anatomical locations – such as stroke, myocardial infarction, and renal failure. Here, we review the shared and unique features of these arteriopathies to provide a better understanding of this family of disorders. Arterial dissections occur commonly in the young to middle-aged, and often in conjunction with hypertension and/or migraine; the latter suggesting they are part of a generalized vasculopathy. Genetic studies as well as cellular and molecular investigations of arterial dissections reveal striking similarities between dissection types, particularly their pathophysiology, which includes the presence or absence of an intimal tear and vasa vasorum dysfunction as a cause of intramural hemorrhage. Pathway perturbations common to all types of dissections include disruption of TGF-β signaling, the extracellular matrix, the cytoskeleton or metabolism, as evidenced by the finding of mutations in critical genes regulating these processes, including LRP1, collagen genes, fibrillin and TGF-β receptors, or their coupled pathways. Perturbances in these connected signaling pathways contribute to phenotype switching in endothelial and vascular smooth muscle cells of the affected artery, in which their physiological quiescent state is lost and replaced by a proliferative activated phenotype. Of interest, dissections in various anatomical locations are associated with distinct sex and age predilections, suggesting involvement of gene and environment interactions in disease pathogenesis. Importantly, these cellular mechanisms are potentially therapeutically targetable. Consideration of arterial dissections as a collective pathology allows insight from the better characterized dissection types, such as that involving the thoracic aorta, to be leveraged to inform the less common forms of dissections, including the potential to apply known therapeutic interventions already clinically available for the former.

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Systematic review and meta-analysis of the clinical characteristics and outcomes of spontanous coronary artery dissection

Cited by 15 publications

References 24 publications

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

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

Adverse events after spontaneous coronary artery dissection

Arterial dissections: Common features and new perspectives

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