Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes
Spontaneous coronary artery dissection (SCAD) was underdiagnosed and poorly understood for decades. It is increasingly recognized as an important cause of myocardial infarction (MI) in women. We aimed to assess the natural history of SCAD, which has not been adequately explored. We performed a multi...
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| Published in | European heart journal Vol. 40; no. 15; pp. 1188 - 1197 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Oxford University Press
14.04.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0195-668X 1522-9645 1522-9645 |
| DOI | 10.1093/eurheartj/ehz007 |
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| Abstract | Spontaneous coronary artery dissection (SCAD) was underdiagnosed and poorly understood for decades. It is increasingly recognized as an important cause of myocardial infarction (MI) in women. We aimed to assess the natural history of SCAD, which has not been adequately explored.
We performed a multicentre, prospective, observational study of patients with non-atherosclerotic SCAD presenting acutely from 22 centres in North America. Institutional ethics approval and patient consents were obtained. We recorded baseline demographics, in-hospital characteristics, precipitating/predisposing conditions, angiographic features (assessed by core laboratory), in-hospital major adverse events (MAE), and 30-day major adverse cardiovascular events (MACE). We prospectively enrolled 750 SCAD patients from June 2014 to June 2018. Mean age was 51.8 ± 10.2 years, 88.5% were women (55.0% postmenopausal), 87.7% were Caucasian, and 33.9% had no cardiac risk factors. Emotional stress was reported in 50.3%, and physical stress in 28.9% (9.8% lifting >50 pounds). Predisposing conditions included fibromuscular dysplasia 31.1% (45.2% had no/incomplete screening), systemic inflammatory diseases 4.7%, peripartum 4.5%, and connective tissue disorders 3.6%. Most were treated conservatively (84.3%), but 14.1% underwent percutaneous coronary intervention and 0.7% coronary artery bypass surgery. In-hospital composite MAE was 8.8%; peripartum SCAD patients had higher in-hospital MAE (20.6% vs. 8.2%, P = 0.023). Overall 30-day MACE was 8.8%. Peripartum SCAD and connective tissue disease were independent predictors of 30-day MACE.
Spontaneous coronary artery dissection predominantly affects women and presents with MI. Despite majority of patients being treated conservatively, survival was good. However, significant cardiovascular complications occurred within 30 days. Long-term follow-up and further investigations on management are warranted. |
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| AbstractList | Spontaneous coronary artery dissection (SCAD) was underdiagnosed and poorly understood for decades. It is increasingly recognized as an important cause of myocardial infarction (MI) in women. We aimed to assess the natural history of SCAD, which has not been adequately explored.
We performed a multicentre, prospective, observational study of patients with non-atherosclerotic SCAD presenting acutely from 22 centres in North America. Institutional ethics approval and patient consents were obtained. We recorded baseline demographics, in-hospital characteristics, precipitating/predisposing conditions, angiographic features (assessed by core laboratory), in-hospital major adverse events (MAE), and 30-day major adverse cardiovascular events (MACE). We prospectively enrolled 750 SCAD patients from June 2014 to June 2018. Mean age was 51.8 ± 10.2 years, 88.5% were women (55.0% postmenopausal), 87.7% were Caucasian, and 33.9% had no cardiac risk factors. Emotional stress was reported in 50.3%, and physical stress in 28.9% (9.8% lifting >50 pounds). Predisposing conditions included fibromuscular dysplasia 31.1% (45.2% had no/incomplete screening), systemic inflammatory diseases 4.7%, peripartum 4.5%, and connective tissue disorders 3.6%. Most were treated conservatively (84.3%), but 14.1% underwent percutaneous coronary intervention and 0.7% coronary artery bypass surgery. In-hospital composite MAE was 8.8%; peripartum SCAD patients had higher in-hospital MAE (20.6% vs. 8.2%, P = 0.023). Overall 30-day MACE was 8.8%. Peripartum SCAD and connective tissue disease were independent predictors of 30-day MACE.
Spontaneous coronary artery dissection predominantly affects women and presents with MI. Despite majority of patients being treated conservatively, survival was good. However, significant cardiovascular complications occurred within 30 days. Long-term follow-up and further investigations on management are warranted. Spontaneous coronary artery dissection (SCAD) was underdiagnosed and poorly understood for decades. It is increasingly recognized as an important cause of myocardial infarction (MI) in women. We aimed to assess the natural history of SCAD, which has not been adequately explored.AIMSSpontaneous coronary artery dissection (SCAD) was underdiagnosed and poorly understood for decades. It is increasingly recognized as an important cause of myocardial infarction (MI) in women. We aimed to assess the natural history of SCAD, which has not been adequately explored.We performed a multicentre, prospective, observational study of patients with non-atherosclerotic SCAD presenting acutely from 22 centres in North America. Institutional ethics approval and patient consents were obtained. We recorded baseline demographics, in-hospital characteristics, precipitating/predisposing conditions, angiographic features (assessed by core laboratory), in-hospital major adverse events (MAE), and 30-day major adverse cardiovascular events (MACE). We prospectively enrolled 750 SCAD patients from June 2014 to June 2018. Mean age was 51.8 ± 10.2 years, 88.5% were women (55.0% postmenopausal), 87.7% were Caucasian, and 33.9% had no cardiac risk factors. Emotional stress was reported in 50.3%, and physical stress in 28.9% (9.8% lifting >50 pounds). Predisposing conditions included fibromuscular dysplasia 31.1% (45.2% had no/incomplete screening), systemic inflammatory diseases 4.7%, peripartum 4.5%, and connective tissue disorders 3.6%. Most were treated conservatively (84.3%), but 14.1% underwent percutaneous coronary intervention and 0.7% coronary artery bypass surgery. In-hospital composite MAE was 8.8%; peripartum SCAD patients had higher in-hospital MAE (20.6% vs. 8.2%, P = 0.023). Overall 30-day MACE was 8.8%. Peripartum SCAD and connective tissue disease were independent predictors of 30-day MACE.METHODS AND RESULTSWe performed a multicentre, prospective, observational study of patients with non-atherosclerotic SCAD presenting acutely from 22 centres in North America. Institutional ethics approval and patient consents were obtained. We recorded baseline demographics, in-hospital characteristics, precipitating/predisposing conditions, angiographic features (assessed by core laboratory), in-hospital major adverse events (MAE), and 30-day major adverse cardiovascular events (MACE). We prospectively enrolled 750 SCAD patients from June 2014 to June 2018. Mean age was 51.8 ± 10.2 years, 88.5% were women (55.0% postmenopausal), 87.7% were Caucasian, and 33.9% had no cardiac risk factors. Emotional stress was reported in 50.3%, and physical stress in 28.9% (9.8% lifting >50 pounds). Predisposing conditions included fibromuscular dysplasia 31.1% (45.2% had no/incomplete screening), systemic inflammatory diseases 4.7%, peripartum 4.5%, and connective tissue disorders 3.6%. Most were treated conservatively (84.3%), but 14.1% underwent percutaneous coronary intervention and 0.7% coronary artery bypass surgery. In-hospital composite MAE was 8.8%; peripartum SCAD patients had higher in-hospital MAE (20.6% vs. 8.2%, P = 0.023). Overall 30-day MACE was 8.8%. Peripartum SCAD and connective tissue disease were independent predictors of 30-day MACE.Spontaneous coronary artery dissection predominantly affects women and presents with MI. Despite majority of patients being treated conservatively, survival was good. However, significant cardiovascular complications occurred within 30 days. Long-term follow-up and further investigations on management are warranted.CONCLUSIONSpontaneous coronary artery dissection predominantly affects women and presents with MI. Despite majority of patients being treated conservatively, survival was good. However, significant cardiovascular complications occurred within 30 days. Long-term follow-up and further investigations on management are warranted. |
| Author | Matteau, Alexis Humphries, Karin Ganesh, Santhi Lutchmedial, Sohrab Minhas, Kunal Har, Bryan So, Derek Starovoytov, Andrew Ibrahim, Reda Gornik, Heather L Vijayaraghavan, Ram Buller, Christopher Aymong, Eve Madan, Mina Brass, Neil Renner, Suzanne Lavi, Shahar Lavoie, Andrea Bishop, Helen Welsh, Robert C Pearce, Colin Ko, Dennis Mancini, Giovanni Battista John Sheth, Tej Martucci, Giuseppe Saw, Jacqueline |
| AuthorAffiliation | 9 London Health Sciences Centre, London, Ontario, Canada 15 Scarborough Cardiology Research, Scaborough, Ontario, Canada 1 Division of Cardiology, Vancouver General Hospital, 2775 Laurel St, 9th Floor, Vancouver, British Columbia, Canada 10 Royal University Hospital, Saskatoon, Saskatchewan, Canada 3 Hamilton General Hospital, Hamilton, Ontario, Canada 7 University of Saskatchewan & Prairie Vascular, Regina, Saskatchewan, Canada 19 Cleveland Clinic Foundation, Cleveland, OH, USA 14 St. John Regional Hospital, St. John, New Brunswick, Canada 16 St. Paul’s Hospital, Vancouver, British Columbia, Canada 12 Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada 8 Queen Elizabeth Health Sciences Centre, Halifax, Nova Scotia, Canada 23 McGill University Health Centre, Montreal, Quebec, Canada 6 Royal Alexandra Hospital, Edmonton, Alberta, Canada 13 University of Alberta, Edmonton, Alberta, Canada 11 St. Mary’s General Hospital, Kitchener, Ontario, Canada 20 University of Michigan, Ann Arbor, MI, USA 22 |
| AuthorAffiliation_xml | – name: 9 London Health Sciences Centre, London, Ontario, Canada – name: 12 Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada – name: 13 University of Alberta, Edmonton, Alberta, Canada – name: 10 Royal University Hospital, Saskatoon, Saskatchewan, Canada – name: 11 St. Mary’s General Hospital, Kitchener, Ontario, Canada – name: 7 University of Saskatchewan & Prairie Vascular, Regina, Saskatchewan, Canada – name: 14 St. John Regional Hospital, St. John, New Brunswick, Canada – name: 16 St. Paul’s Hospital, Vancouver, British Columbia, Canada – name: 3 Hamilton General Hospital, Hamilton, Ontario, Canada – name: 1 Division of Cardiology, Vancouver General Hospital, 2775 Laurel St, 9th Floor, Vancouver, British Columbia, Canada – name: 22 Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada – name: 15 Scarborough Cardiology Research, Scaborough, Ontario, Canada – name: 19 Cleveland Clinic Foundation, Cleveland, OH, USA – name: 5 Saint Boniface General Hospital, Winnipeg, Manitoba, Canada – name: 17 Foothills Hospital, Calgary, Alberta, Canada – name: 20 University of Michigan, Ann Arbor, MI, USA – name: 21 St. Michael’s Hospital, Toronto, Ontario, Canada – name: 4 University of Ottawa Heart Institute, Ottawa, Ontario, Canada – name: 6 Royal Alexandra Hospital, Edmonton, Alberta, Canada – name: 2 BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada – name: 8 Queen Elizabeth Health Sciences Centre, Halifax, Nova Scotia, Canada – name: 18 Montreal Heart Institute, Montreal, Quebec, Canada – name: 23 McGill University Health Centre, Montreal, Quebec, Canada |
| Author_xml | – sequence: 1 givenname: Jacqueline surname: Saw fullname: Saw, Jacqueline organization: Division of Cardiology, Vancouver General Hospital, 2775 Laurel St, 9th Floor, Vancouver, British Columbia, Canada – sequence: 2 givenname: Andrew surname: Starovoytov fullname: Starovoytov, Andrew organization: Division of Cardiology, Vancouver General Hospital, 2775 Laurel St, 9th Floor, Vancouver, British Columbia, Canada – sequence: 3 givenname: Karin surname: Humphries fullname: Humphries, Karin organization: BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada – sequence: 4 givenname: Tej surname: Sheth fullname: Sheth, Tej organization: Hamilton General Hospital, Hamilton, Ontario, Canada – sequence: 5 givenname: Derek surname: So fullname: So, Derek organization: University of Ottawa Heart Institute, Ottawa, Ontario, Canada – sequence: 6 givenname: Kunal surname: Minhas fullname: Minhas, Kunal organization: Saint Boniface General Hospital, Winnipeg, Manitoba, Canada – sequence: 7 givenname: Neil surname: Brass fullname: Brass, Neil organization: Royal Alexandra Hospital, Edmonton, Alberta, Canada – sequence: 8 givenname: Andrea surname: Lavoie fullname: Lavoie, Andrea organization: University of Saskatchewan & Prairie Vascular, Regina, Saskatchewan, Canada – sequence: 9 givenname: Helen surname: Bishop fullname: Bishop, Helen organization: Queen Elizabeth Health Sciences Centre, Halifax, Nova Scotia, Canada – sequence: 10 givenname: Shahar surname: Lavi fullname: Lavi, Shahar organization: London Health Sciences Centre, London, Ontario, Canada – sequence: 11 givenname: Colin surname: Pearce fullname: Pearce, Colin organization: Royal University Hospital, Saskatoon, Saskatchewan, Canada – sequence: 12 givenname: Suzanne surname: Renner fullname: Renner, Suzanne organization: St. Mary’s General Hospital, Kitchener, Ontario, Canada – sequence: 13 givenname: Mina surname: Madan fullname: Madan, Mina organization: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada – sequence: 14 givenname: Robert C surname: Welsh fullname: Welsh, Robert C organization: University of Alberta, Edmonton, Alberta, Canada – sequence: 15 givenname: Sohrab surname: Lutchmedial fullname: Lutchmedial, Sohrab organization: St. John Regional Hospital, St. John, New Brunswick, Canada – sequence: 16 givenname: Ram surname: Vijayaraghavan fullname: Vijayaraghavan, Ram organization: Scarborough Cardiology Research, Scaborough, Ontario, Canada – sequence: 17 givenname: Eve surname: Aymong fullname: Aymong, Eve organization: St. Paul’s Hospital, Vancouver, British Columbia, Canada – sequence: 18 givenname: Bryan surname: Har fullname: Har, Bryan organization: Foothills Hospital, Calgary, Alberta, Canada – sequence: 19 givenname: Reda surname: Ibrahim fullname: Ibrahim, Reda organization: Montreal Heart Institute, Montreal, Quebec, Canada – sequence: 20 givenname: Heather L surname: Gornik fullname: Gornik, Heather L organization: Cleveland Clinic Foundation, Cleveland, OH, USA – sequence: 21 givenname: Santhi surname: Ganesh fullname: Ganesh, Santhi organization: University of Michigan, Ann Arbor, MI, USA – sequence: 22 givenname: Christopher surname: Buller fullname: Buller, Christopher organization: St. Michael’s Hospital, Toronto, Ontario, Canada – sequence: 23 givenname: Alexis surname: Matteau fullname: Matteau, Alexis organization: Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada – sequence: 24 givenname: Giuseppe surname: Martucci fullname: Martucci, Giuseppe organization: McGill University Health Centre, Montreal, Quebec, Canada – sequence: 25 givenname: Dennis surname: Ko fullname: Ko, Dennis organization: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada – sequence: 26 givenname: Giovanni Battista John surname: Mancini fullname: Mancini, Giovanni Battista John organization: Division of Cardiology, Vancouver General Hospital, 2775 Laurel St, 9th Floor, Vancouver, British Columbia, Canada |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30698711$$D View this record in MEDLINE/PubMed |
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| Keywords | Women Percutaneous coronary intervention (PCI) Fibromuscular dysplasia (FMD) Peripartum Myocardial infarction (MI) Spontaneous coronary artery dissection (SCAD) |
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| References | Tweet (2019041404583637600_ehz007-B24) 2017; 70 Mahmoud (2019041404583637600_ehz007-B3) 2018; 11 Alderman (2019041404583637600_ehz007-B8) 1992; 3 Vijayaraghavan (2019041404583637600_ehz007-B9) 2014; 130 Thygesen (2019041404583637600_ehz007-B14) 2012; 33 Saw (2019041404583637600_ehz007-B6) 2014; 84 Hayes (2019041404583637600_ehz007-B2) 2018; 137 Saw (2019041404583637600_ehz007-B16) 2017; 70 Saw (2019041404583637600_ehz007-B4) 2014; 30 Koul (2019041404583637600_ehz007-B13) 2001; 52 Lettieri (2019041404583637600_ehz007-B18) 2015; 116 Saw (2019041404583637600_ehz007-B10) 2014; 7 Olin (2019041404583637600_ehz007-B12) 2014; 129 Saw (2019041404583637600_ehz007-B1) 2016; 68 Adlam (2019041404583637600_ehz007-B7) 2018; 39 Saw (2019041404583637600_ehz007-B11) 2013; 6 Tweet (2019041404583637600_ehz007-B22) 2012; 126 Main (2019041404583637600_ehz007-B15) 2017; 13 Chou (2019041404583637600_ehz007-B23) 2016; 32 Tweet (2019041404583637600_ehz007-B20) 2014; 7 Saw (2019041404583637600_ehz007-B5) 2016; 87 Rogowski (2019041404583637600_ehz007-B19) 2017; 89 Prakash (2019041404583637600_ehz007-B25) 2016; 9 Roura (2019041404583637600_ehz007-B21) 2016; 9 Alfonso (2019041404583637600_ehz007-B17) 2012; 5 30844061 - Eur Heart J. 2019 Apr 14;40(15):1198-1201. doi: 10.1093/eurheartj/ehz048 |
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