Bryan J. Wells’s research while affiliated with Emory University and other places

Introduction: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of myocardial infarction. Migraine headache has been reported to be common among patients with SCAD, but the degree of migraine-related disability has not been quantified. Methods: Clinical data and headache variables were obtained from the baseline assessment of the prospective, multicenter iSCAD Registry. Migraine-related disability was quantified using the self-reported Migraine Disability Assessment (MIDAS). Demographic, clinical, psychosocial, and medical characteristics from data entry forms were compared between patients with and without migraine. Results: Of the 773 patients with available data, 46% reported previous or current migraines. Those with migraines were more likely to be women (96.9% vs 90.3%, p = 0.0003). The presence of underlying carotid fibromuscular dysplasia was associated with migraine (35% vs 27%, p = 0.0175). There was not a significant association with carotid artery dissection and migraine. Current migraine frequency was less than monthly (58%), monthly (24%), weekly (16%), and daily (3%). Triptan use was reported in 32.5% of patients, and 17.5% used daily migraine prophylactic medications. Using the MIDAS to quantify disability related to migraine, 60.2% reported little or no disability, 14.4% mild, 12.7% moderate, and 12.7% severe. The mean MIDAS score was 9.9 (mild to moderate disability). Patients with SCAD had higher rates of depression and anxiety (28.2% vs 17.7% [p = 0.0004] and 35.3% vs 26.7% [p = 0.0099], respectively). Conclusions: Migraines are common, frequent, and a source of disability in patients with SCAD. The association between female sex, anxiety, and depression may provide some insight for potential treatment modalities.

Background Myocardial infarction secondary to spontaneous coronary artery dissection (SCAD) can be traumatic and potentially trigger posttraumatic stress disorder (PTSD). In a large, multicenter, registry‐based cohort, we documented prevalence of lifetime and past‐month SCAD‐induced PTSD, as well as related treatment seeking, and examined a range of health‐relevant correlates of SCAD‐induced PTSD. Methods and Results Patients with SCAD were enrolled in the iSCAD (International SCAD) Registry. At baseline, site investigators completed medical report forms, and patients reported demographics, medical/SCAD history, psychosocial factors (including SCAD‐induced PTSD symptoms), health behaviors, and health status via online questionnaires. Of 1156 registry patients, 859 patients (93.9% women; mean age, 52.3 years) completed questionnaires querying SCAD‐induced PTSD. Nearly 35% (n=298) of patients met diagnostic criteria for probable SCAD‐induced PTSD in their lifetime, and 6.4% (n=55) met criteria for probable past‐month PTSD. Of 811 patients ever reporting any SCAD‐induced PTSD symptoms, 34.8% indicated seeking treatment for this distress. However, 46.0% of the 298 patients with lifetime probable SCAD‐induced PTSD diagnoses reported never receiving trauma‐related treatment. Younger age at first SCAD, fewer years since SCAD, being single, unemployed status, more lifetime trauma, and history of anxiety were associated with greater past‐month PTSD symptom severity in multivariable regression models. Greater past‐month SCAD‐induced PTSD symptoms were associated with greater past‐week sleep disturbance and worse past‐month disease‐specific health status when adjusting for various risk factors. Conclusions Given the high prevalence of SCAD‐induced PTSD symptoms, efforts to support screening for these symptoms and connecting patients experiencing distress with empirically supported treatments are critical next steps. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04496687.

This review highlights sex- and gender-specific considerations in cardiovascular diseases with a particular focus on pathophysiology, epidemiology, clinical presentation, risk factors, diagnosis, and management of spontaneous coronary artery dissection. It aims to summarize the most up to date evidence and gaps in knowledge that exist in the spontaneous coronary artery dissection space while highlighting salient points with regards to sex- and gender-based differences in clinical implications, current management, and recommended counseling practices.

Purpose of review Venous thromboembolism (VTE) is a common complication of COVID-19 infection. Throughout the COVID-19 pandemic, clinicians have faced the task of attempting to best prevent VTE while also balancing the associated risks of anticoagulation. Early in the pandemic, protocols differed by institution and clinician. This paper seeks to examine current available evidence and guidelines in order to clarify and provide recommendations on which prophylactic interventions should be used for patients, depending on the clinical scenario. Recent findings A randomized control trial (RCT) performed in 2021 revealed that critically ill patients who receive therapeutic anticoagulation do not have better outcomes than those who receive standard thromboprophylaxis. An RCT studying non-critically ill hospitalized patients revealed therapeutic anticoagulation increased organ-support free days. Study of COVID-19 outpatients reveals no clinical benefit of therapeutic or prophylactic anticoagulation. Summary Given these findings as well as recommendations from the American Society of Hematology, we conclude that patients who are critically ill should receive standard thromboprophylaxis, floor patients should receive therapeutic anticoagulation, and outpatients should receive neither. There is growing research in the field of treatment in VTE in COVID-19 patients. Based on the American College of Chest Physician guidelines, there are similar treatment recommendations for COVID-19 positive and negative patients diagnosed with a VTE. Due to caution regarding disease transmission and staff safety, there were not initial strong pushes toward invasive therapies and a focus was placed on medication management. With the availability of disease transmission and appropriate personal protective equipment (PPE) stocks, there is now consideration to pursue these catheter or surgical-based interventions. These recommendations may change in the future. Further research should be conducted, especially as new variants emerge and populations demonstrate increased immunity, both via vaccines and through natural infection.