Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes
BACKGROUND—Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described. METHODS AND RESULTS—Patien...
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| Published in | Circulation. Cardiovascular interventions Vol. 7; no. 5; pp. 645 - 655 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
American Heart Association, Inc
01.10.2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1941-7640 1941-7632 1941-7632 |
| DOI | 10.1161/CIRCINTERVENTIONS.114.001760 |
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| Abstract | BACKGROUND—Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described.
METHODS AND RESULTS—Patients with NA-SCAD prospectively evaluated (retrospectively or prospectively identified) at Vancouver General Hospital were included. Angiographic SCAD diagnosis was confirmed by 2 experienced interventional cardiologists and categorized as type 1 (multiple lumen), 2 (diffuse stenosis), or 3 (mimic atherosclerosis). Fibromuscular dysplasia screening of renal, iliac, and cerebrovascular arteries were performed with angiography or computed tomographic angiography/MR angiography. Baseline, predisposing and precipitating conditions, angiographic, revascularization, in-hospital, and long-term events were recorded. We prospectively evaluated 168 patients with NA-SCAD. Average age was 52.1±9.2 years, 92.3% were women (62.3% postmenopausal). All presented with myocardial infarction. ECG showed ST-segment elevation in 26.1%, and 3.6% had ventricular tachycardia/ventricular fibrillation arrest. Fibromuscular dysplasia was diagnosed in 72.0%. Precipitating emotional or physical stress was reported in 56.5%. Majority had type 2 angiographic SCAD (67.0%), only 29.1% had type 1, and 3.9% had type 3. The majority (134/168) were initially treated conservatively. Overall, 6 of 168 patients had coronary artery bypass surgery and 33 of 168 had percutaneous coronary intervention in-hospital. Of those treated conservatively (n=134), 3 required revascularization for SCAD extension, and all 79 who had repeat angiogram ≥26 days later had spontaneous healing. Two-year major adverse cardiac events were 16.9% (retrospectively identified group) and 10.4% (prospectively identified group). Recurrent SCAD occurred in 13.1%.
CONCLUSIONS—Majority of patients with NA-SCAD had fibromuscular dysplasia and type 2 angiographic SCAD. Conservative therapy was associated with spontaneous healing. NA-SCAD survivors are at risk for recurrent cardiovascular events, including recurrent SCAD. |
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| AbstractList | Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described.
Patients with NA-SCAD prospectively evaluated (retrospectively or prospectively identified) at Vancouver General Hospital were included. Angiographic SCAD diagnosis was confirmed by 2 experienced interventional cardiologists and categorized as type 1 (multiple lumen), 2 (diffuse stenosis), or 3 (mimic atherosclerosis). Fibromuscular dysplasia screening of renal, iliac, and cerebrovascular arteries were performed with angiography or computed tomographic angiography/MR angiography. Baseline, predisposing and precipitating conditions, angiographic, revascularization, in-hospital, and long-term events were recorded. We prospectively evaluated 168 patients with NA-SCAD. Average age was 52.1±9.2 years, 92.3% were women (62.3% postmenopausal). All presented with myocardial infarction. ECG showed ST-segment elevation in 26.1%, and 3.6% had ventricular tachycardia/ventricular fibrillation arrest. Fibromuscular dysplasia was diagnosed in 72.0%. Precipitating emotional or physical stress was reported in 56.5%. Majority had type 2 angiographic SCAD (67.0%), only 29.1% had type 1, and 3.9% had type 3. The majority (134/168) were initially treated conservatively. Overall, 6 of 168 patients had coronary artery bypass surgery and 33 of 168 had percutaneous coronary intervention in-hospital. Of those treated conservatively (n=134), 3 required revascularization for SCAD extension, and all 79 who had repeat angiogram ≥26 days later had spontaneous healing. Two-year major adverse cardiac events were 16.9% (retrospectively identified group) and 10.4% (prospectively identified group). Recurrent SCAD occurred in 13.1%.
Majority of patients with NA-SCAD had fibromuscular dysplasia and type 2 angiographic SCAD. Conservative therapy was associated with spontaneous healing. NA-SCAD survivors are at risk for recurrent cardiovascular events, including recurrent SCAD. BACKGROUND—Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described. METHODS AND RESULTS—Patients with NA-SCAD prospectively evaluated (retrospectively or prospectively identified) at Vancouver General Hospital were included. Angiographic SCAD diagnosis was confirmed by 2 experienced interventional cardiologists and categorized as type 1 (multiple lumen), 2 (diffuse stenosis), or 3 (mimic atherosclerosis). Fibromuscular dysplasia screening of renal, iliac, and cerebrovascular arteries were performed with angiography or computed tomographic angiography/MR angiography. Baseline, predisposing and precipitating conditions, angiographic, revascularization, in-hospital, and long-term events were recorded. We prospectively evaluated 168 patients with NA-SCAD. Average age was 52.1±9.2 years, 92.3% were women (62.3% postmenopausal). All presented with myocardial infarction. ECG showed ST-segment elevation in 26.1%, and 3.6% had ventricular tachycardia/ventricular fibrillation arrest. Fibromuscular dysplasia was diagnosed in 72.0%. Precipitating emotional or physical stress was reported in 56.5%. Majority had type 2 angiographic SCAD (67.0%), only 29.1% had type 1, and 3.9% had type 3. The majority (134/168) were initially treated conservatively. Overall, 6 of 168 patients had coronary artery bypass surgery and 33 of 168 had percutaneous coronary intervention in-hospital. Of those treated conservatively (n=134), 3 required revascularization for SCAD extension, and all 79 who had repeat angiogram ≥26 days later had spontaneous healing. Two-year major adverse cardiac events were 16.9% (retrospectively identified group) and 10.4% (prospectively identified group). Recurrent SCAD occurred in 13.1%. CONCLUSIONS—Majority of patients with NA-SCAD had fibromuscular dysplasia and type 2 angiographic SCAD. Conservative therapy was associated with spontaneous healing. NA-SCAD survivors are at risk for recurrent cardiovascular events, including recurrent SCAD. Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described.BACKGROUNDNonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described.Patients with NA-SCAD prospectively evaluated (retrospectively or prospectively identified) at Vancouver General Hospital were included. Angiographic SCAD diagnosis was confirmed by 2 experienced interventional cardiologists and categorized as type 1 (multiple lumen), 2 (diffuse stenosis), or 3 (mimic atherosclerosis). Fibromuscular dysplasia screening of renal, iliac, and cerebrovascular arteries were performed with angiography or computed tomographic angiography/MR angiography. Baseline, predisposing and precipitating conditions, angiographic, revascularization, in-hospital, and long-term events were recorded. We prospectively evaluated 168 patients with NA-SCAD. Average age was 52.1±9.2 years, 92.3% were women (62.3% postmenopausal). All presented with myocardial infarction. ECG showed ST-segment elevation in 26.1%, and 3.6% had ventricular tachycardia/ventricular fibrillation arrest. Fibromuscular dysplasia was diagnosed in 72.0%. Precipitating emotional or physical stress was reported in 56.5%. Majority had type 2 angiographic SCAD (67.0%), only 29.1% had type 1, and 3.9% had type 3. The majority (134/168) were initially treated conservatively. Overall, 6 of 168 patients had coronary artery bypass surgery and 33 of 168 had percutaneous coronary intervention in-hospital. Of those treated conservatively (n=134), 3 required revascularization for SCAD extension, and all 79 who had repeat angiogram ≥26 days later had spontaneous healing. Two-year major adverse cardiac events were 16.9% (retrospectively identified group) and 10.4% (prospectively identified group). Recurrent SCAD occurred in 13.1%.METHODS AND RESULTSPatients with NA-SCAD prospectively evaluated (retrospectively or prospectively identified) at Vancouver General Hospital were included. Angiographic SCAD diagnosis was confirmed by 2 experienced interventional cardiologists and categorized as type 1 (multiple lumen), 2 (diffuse stenosis), or 3 (mimic atherosclerosis). Fibromuscular dysplasia screening of renal, iliac, and cerebrovascular arteries were performed with angiography or computed tomographic angiography/MR angiography. Baseline, predisposing and precipitating conditions, angiographic, revascularization, in-hospital, and long-term events were recorded. We prospectively evaluated 168 patients with NA-SCAD. Average age was 52.1±9.2 years, 92.3% were women (62.3% postmenopausal). All presented with myocardial infarction. ECG showed ST-segment elevation in 26.1%, and 3.6% had ventricular tachycardia/ventricular fibrillation arrest. Fibromuscular dysplasia was diagnosed in 72.0%. Precipitating emotional or physical stress was reported in 56.5%. Majority had type 2 angiographic SCAD (67.0%), only 29.1% had type 1, and 3.9% had type 3. The majority (134/168) were initially treated conservatively. Overall, 6 of 168 patients had coronary artery bypass surgery and 33 of 168 had percutaneous coronary intervention in-hospital. Of those treated conservatively (n=134), 3 required revascularization for SCAD extension, and all 79 who had repeat angiogram ≥26 days later had spontaneous healing. Two-year major adverse cardiac events were 16.9% (retrospectively identified group) and 10.4% (prospectively identified group). Recurrent SCAD occurred in 13.1%.Majority of patients with NA-SCAD had fibromuscular dysplasia and type 2 angiographic SCAD. Conservative therapy was associated with spontaneous healing. NA-SCAD survivors are at risk for recurrent cardiovascular events, including recurrent SCAD.CONCLUSIONSMajority of patients with NA-SCAD had fibromuscular dysplasia and type 2 angiographic SCAD. Conservative therapy was associated with spontaneous healing. NA-SCAD survivors are at risk for recurrent cardiovascular events, including recurrent SCAD. |
| Author | Robinson, Simon Aymong, Eve Vuurmans, Tycho Humphries, Karin Buller, Christopher E. Sedlak, Tara Gao, Min Mancini, G.B. John Ricci, Donald Saw, Jacqueline Starovoytov, Andrew |
| AuthorAffiliation | From the Division of Cardiology, Vancouver General Hospital, Vancouver, BC (J.S., T.S., A.S., D.R., G.B.J.M.); Division of Cardiology, St Paul’s Hospital, Vancouver, BC (E.A.); Division of Cardiology, St Michael’s Hospital, Toronto, Ontario (C.E.B.); Division of Cardiology, Royal Jubilee Hospital, Victoria, BC (S.R.); Division of Cardiology, Royal Columbian Hospital, New Westminster, BC (T.V.); and BC Centre for Improved Cardiovascular Health, UBC, Vancouver, BC (M.G., K.H.) |
| AuthorAffiliation_xml | – name: From the Division of Cardiology, Vancouver General Hospital, Vancouver, BC (J.S., T.S., A.S., D.R., G.B.J.M.); Division of Cardiology, St Paul’s Hospital, Vancouver, BC (E.A.); Division of Cardiology, St Michael’s Hospital, Toronto, Ontario (C.E.B.); Division of Cardiology, Royal Jubilee Hospital, Victoria, BC (S.R.); Division of Cardiology, Royal Columbian Hospital, New Westminster, BC (T.V.); and BC Centre for Improved Cardiovascular Health, UBC, Vancouver, BC (M.G., K.H.) |
| Author_xml | – sequence: 1 givenname: Jacqueline surname: Saw fullname: Saw, Jacqueline organization: From the Division of Cardiology, Vancouver General Hospital, Vancouver, BC (J.S., T.S., A.S., D.R., G.B.J.M.); Division of Cardiology, St Paul’s Hospital, Vancouver, BC (E.A.); Division of Cardiology, St Michael’s Hospital, Toronto, Ontario (C.E.B.); Division of Cardiology, Royal Jubilee Hospital, Victoria, BC (S.R.); Division of Cardiology, Royal Columbian Hospital, New Westminster, BC (T.V.); and BC Centre for Improved Cardiovascular Health, UBC, Vancouver, BC (M.G., K.H.) – sequence: 2 givenname: Eve surname: Aymong fullname: Aymong, Eve – sequence: 3 givenname: Tara surname: Sedlak fullname: Sedlak, Tara – sequence: 4 givenname: Christopher surname: Buller middlename: E. fullname: Buller, Christopher E. – sequence: 5 givenname: Andrew surname: Starovoytov fullname: Starovoytov, Andrew – sequence: 6 givenname: Donald surname: Ricci fullname: Ricci, Donald – sequence: 7 givenname: Simon surname: Robinson fullname: Robinson, Simon – sequence: 8 givenname: Tycho surname: Vuurmans fullname: Vuurmans, Tycho – sequence: 9 givenname: Min surname: Gao fullname: Gao, Min – sequence: 10 givenname: Karin surname: Humphries fullname: Humphries, Karin – sequence: 11 givenname: G.B. surname: Mancini middlename: John fullname: Mancini, G.B. John |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25294399$$D View this record in MEDLINE/PubMed |
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| Snippet | BACKGROUND—Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young... Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The... |
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| SubjectTerms | Adult Canada Causality Coronary Angiography Coronary Vessel Anomalies - epidemiology Coronary Vessel Anomalies - etiology Coronary Vessels - diagnostic imaging Coronary Vessels - pathology Coronary Vessels - surgery Female Fibromuscular Dysplasia - diagnosis Fibromuscular Dysplasia - epidemiology Fibromuscular Dysplasia - surgery Follow-Up Studies Humans Male Myocardial Infarction - diagnosis Myocardial Infarction - epidemiology Myocardial Infarction - surgery Outcome Assessment (Health Care) Percutaneous Coronary Intervention Prospective Studies Risk Factors Stress, Psychological - epidemiology Vascular Diseases - congenital Vascular Diseases - epidemiology Vascular Diseases - etiology Young Adult |
| Title | Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes |
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