1. Clinical features, management, and prognosis of spontaneous coronary artery dissection
- Author
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Patricia J.M. Best, Amir Lerman, Rajiv Gulati, Bernard J. Gersh, Charanjit S. Rihal, Sridevi R. Pitta, Robert D. Simari, Marysia S. Tweet, Sherezade Khambatta, Ryan J. Lennon, and Sharonne N. Hayes
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Fibromuscular dysplasia ,Kaplan-Meier Estimate ,Spontaneous coronary artery dissection (SCAD) ,Aneurysm, Ruptured ,Coronary Angiography ,Cohort Studies ,Electrocardiography ,Sex Factors ,Recurrence ,Physiology (medical) ,Internal medicine ,Angioplasty ,medicine ,Humans ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Coronary Artery Bypass ,Retrospective Studies ,Rupture, Spontaneous ,business.industry ,Coronary Aneurysm ,Percutaneous coronary intervention ,Disease Management ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Prognosis ,Treatment Outcome ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Scad ,business ,Cohort study - Abstract
Background— Spontaneous coronary artery dissection (SCAD) is an acute coronary event of uncertain origin. 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 were evaluated. Mean age was 42.6 years; 82% were female. Extreme exertion at SCAD onset was more frequent in men (7 of 16 versus 2 of 71; P Conclusions— SCAD affects a young, predominantly female population, frequently presenting as ST-elevation myocardial infarction. Although in-hospital mortality is low regardless of initial treatment, percutaneous coronary intervention is associated with high rates of complication. Risks of SCAD recurrence and major adverse cardiac events in the long term emphasize the need for close follow-up. Fibromuscular dysplasia is a novel association and potentially causative factor.
- Published
- 2012