Spontaneous coronary artery dissection: aggressive vs. conservative therapy.
ABSTRACT Spontaneous coronary artery dissection (SCAD) is a rare condition that commonly presents as an acute coronary event in the younger population, especially in females of childbearing age. Generally, there is no consensus on the etiology, prognosis, and treatment of SCAD.
The Medline database was searched for "spontaneous coronary artery dissection" between 1931 and 2008. A total of 440 cases of SCAD were identified. Demographic data were analyzed with either the Student's t-test or the chi-square test for categorical and nominal variables, respectively. Kaplan-Meier outcome analysis was used to assess the outcome of a given treatment for all patients after 1990.
SCAD was found more commonly in females with 308 (70%) cases. Pregnancy was associated with SCAD in 80 (26.1%) cases. Among pregnant patients, 67 (83.8%) developed SCAD in the postpartum period and 13 (16.2%) patients in the prepartum period. Analysis of treatment modalities showed that 21.2% of the patients who were conservatively managed after the initial diagnosis eventually required surgical or catheter-based intervention compared to 2.5% of patients who were initially treated with an aggressive strategy. Kaplan-Meier analysis showed that patients with an isolated single lesion in left or right coronary artery had a statistically significant better outcome when treated with an early aggressive strategy, including coronary artery bypass grafting (CABG) or stent placement as compared to a conservative strategy (p = 0.023, p = 0.006, respectively).
Early intervention with either CABG or percutaneous coronary intervention following the diagnosis of SCAD leads to a better outcome and less need for further intervention.
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ABSTRACT: The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 ± 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis. Copyright © 2015 Elsevier Inc. All rights reserved.The American journal of cardiology 04/2015; DOI:10.1016/j.amjcard.2015.03.039 · 3.43 Impact Factor
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ABSTRACT: Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and its diagnosis is made by necropsy in more than 70% of the cases. Optimal treatment is still uncertain, and the treatment options are percutaneous coronary intervention, coronary artery bypass surgery and medical therapy. The objective of this study was to evaluate the clinical characteristics, treatment modalities and outcome of a series of cases with spontaneous coronary artery dissection.
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ABSTRACT: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction and sudden cardiac death. It occurs most commonly in otherwise healthy women during pregnancy or the postpartum period. The true incidence of SCAD is underestimated, as most cases are diagnosed at autopsy. The pathophysiology of SCAD is still not fully understood, and its management can be challenging. This report describes a 35-year-old pregnant female who presented with an acute antero-lateral ST elevation secondary to spontaneous dissection of the left anterior descending artery and the circumflex artery. The diagnosis was established by coronary artery angiography. However, the patient died following cardiac tamponade. The examination of this case represented a starting point for the reviewing of the diagnosis, clinical course, and management of SCAD, and for the placing of this in context with the existing literature. This study highlights the importance of prompt diagnosis and subsequent lifesaving treatment. © 2015 American Academy of Forensic Sciences.Journal of Forensic Sciences 02/2015; 60(3). DOI:10.1111/1556-4029.12722 · 1.31 Impact Factor