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Clinical Features, Management and Prognosis of Spontaneous Coronary Artery Dissection.
MedLine Citation:
PMID:  22800851     Owner:  NLM     Status:  Publisher    
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an acute coronary event of uncertain etiology. Clinical features and prognosis remain insufficiently characterized. METHODS AND RESULTS: A retrospective single-center cohort study identified 87 patients with angiographically confirmed SCAD. Incidence, clinical characteristics, treatment modalities, in-hospital outcomes and long-term risk of SCAD recurrence or major adverse cardiac events (MACE) were evaluated. Mean age was 42.6 years and 82% were female. Extreme exertion at SCAD onset was more frequent in males (7/16 vs 2/71, p<0.001) and postpartum status was observed in 13/71(18%) females. Presentation was ST-elevation myocardial infarction (STEMI) in 49%. Multivessel SCAD was found in 23%. Initial conservative management (31/87) and coronary artery bypass grafting (7/87) were associated with an uncomplicated in-hospital course, whereas percutaneous coronary intervention (PCI) was complicated by technical failure in 15/43(35%) and one death. During median follow-up of 47 months [IQR 18,106], SCAD recurred in 15 patients, all female. Estimated ten-year rate of MACE (death, heart failure, myocardial infarction and SCAD recurrence) was 47%. Fibromuscular dysplasia (FMD) of the iliac artery was identified incidentally in 8/16 (50%) femoral angiograms undertaken prior to closure device placement and in the carotid arteries of two others with carotid dissection. CONCLUSIONS: SCAD affects a young, predominantly female population, frequently presenting as STEMI. While in-hospital mortality is low regardless of initial treatment, PCI is associated with high rates of complication. Risks of SCAD recurrence and MACE in the long-term emphasize the need for close follow-up. FMD is a novel association and potentially causative factor.
Marysia S Tweet; Sharonne N Hayes; Sridevi R Pitta; Robert D Simari; Amir Lerman; Ryan J Lennon; Bernard J Gersh; Sherezade Khambatta; Patricia J M Best; Charanjit S Rihal; Rajiv Gulati
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-16
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 Mayo Clinic, Rochester, MN;
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