Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection
[Display omitted] Spontaneous coronary artery dissection (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome. Indications for revascularization and long-term outcomes of SCAD remain areas of active investigation. We report our experience with initial management strateg...
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| Veröffentlicht in: | Seminars in thoracic and cardiovascular surgery 2024, Vol.36 (4), p.387-397 |
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| creator | Jensen, Christopher W. Kang, Lillian Moya-Mendez, Mary E. Rhodin, Kristen E. Vekstein, Andrew M. Schuyler Jones, W. Rymer, Jennifer A. Zwischenberger, Brittany A. Williams, Adam R. |
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Spontaneous coronary artery dissection (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome. Indications for revascularization and long-term outcomes of SCAD remain areas of active investigation. We report our experience with initial management strategy and long-term outcomes in SCAD. We reviewed all patients treated at our institution from 1996-2021 with a SCAD diagnosis. Demographics, comorbidities, clinical presentations, angiography findings, and management strategies were obtained by chart review. The primary outcome was a composite of cardiac death, recurrent/progressive SCAD, subsequent diagnosis of congestive heart failure, or subsequent/repeat revascularization after the initial management. Unadjusted Kaplan-Meier survival analysis was performed. Of 186 patients with a SCAD diagnosis treated at our institution, 149 (80%) were female. Medical management was the initial treatment in 134 (72.0%) patients, percutaneous coronary intervention (PCI) in 43 (23.1%), and coronary artery bypass grafting in 9 (4.8%). Surgery/PCI intervention was associated with younger age (38.8 vs 47.7 years, P = 0.01), ST elevation myocardial infarction on presentation (67.0% vs 34.0%, P |
| doi_str_mv | 10.1053/j.semtcvs.2023.05.001 |
| format | Article |
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Spontaneous coronary artery dissection (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome. Indications for revascularization and long-term outcomes of SCAD remain areas of active investigation. We report our experience with initial management strategy and long-term outcomes in SCAD. We reviewed all patients treated at our institution from 1996-2021 with a SCAD diagnosis. Demographics, comorbidities, clinical presentations, angiography findings, and management strategies were obtained by chart review. The primary outcome was a composite of cardiac death, recurrent/progressive SCAD, subsequent diagnosis of congestive heart failure, or subsequent/repeat revascularization after the initial management. Unadjusted Kaplan-Meier survival analysis was performed. Of 186 patients with a SCAD diagnosis treated at our institution, 149 (80%) were female. Medical management was the initial treatment in 134 (72.0%) patients, percutaneous coronary intervention (PCI) in 43 (23.1%), and coronary artery bypass grafting in 9 (4.8%). Surgery/PCI intervention was associated with younger age (38.8 vs 47.7 years, P = 0.01), ST elevation myocardial infarction on presentation (67.0% vs 34.0%, P < 0.001), lower ejection fraction (45.0% vs 55.0%, P = 0.002), and left anterior descending coronary artery dissection (75.0% vs 51.0%, P = 0.006). Ten-year freedom from our composite outcome was similar between revascularized patients and those managed with medical therapy (P = 0.36). Median follow-up time was 4.5 years. SCAD in the setting of ST elevation myocardial infarction, left anterior descending coronary artery involvement, or decreased cardiac function suggests greater ischemic insult and was associated with initial percutaneous or surgical revascularization. Despite worse disease on initial presentation, long-term outcomes of patients undergoing revascularization are similar to medically managed patients with SCAD.</description><identifier>ISSN: 1043-0679</identifier><identifier>ISSN: 1532-9488</identifier><identifier>EISSN: 1532-9488</identifier><identifier>DOI: 10.1053/j.semtcvs.2023.05.001</identifier><identifier>PMID: 37633623</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; CABG ; Cardiovascular Agents - therapeutic use ; Coronary Angiography ; Coronary Artery Bypass - adverse effects ; Coronary Artery Bypass - mortality ; Coronary Vessel Anomalies - complications ; Coronary Vessel Anomalies - diagnostic imaging ; Coronary Vessel Anomalies - mortality ; Coronary Vessel Anomalies - surgery ; Coronary Vessel Anomalies - therapy ; Female ; Humans ; Male ; Middle Aged ; Myocardial infarction ; PCI ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - mortality ; Recurrence ; Retrospective Studies ; Risk Assessment ; Risk Factors ; SCAD ; Spontaneous coronary artery dissection ; STEMI ; Time Factors ; Treatment Outcome ; Vascular Diseases - congenital ; Vascular Diseases - diagnostic imaging ; Vascular Diseases - mortality ; Vascular Diseases - physiopathology ; Vascular Diseases - surgery ; Vascular Diseases - therapy</subject><ispartof>Seminars in thoracic and cardiovascular surgery, 2024, Vol.36 (4), p.387-397</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3161-7a09ba459fbca92293ac9bf899e8cd3006fce654d05a8c9130de11affb790a6a3</citedby><cites>FETCH-LOGICAL-c3161-7a09ba459fbca92293ac9bf899e8cd3006fce654d05a8c9130de11affb790a6a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1053/j.semtcvs.2023.05.001$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37633623$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jensen, Christopher W.</creatorcontrib><creatorcontrib>Kang, Lillian</creatorcontrib><creatorcontrib>Moya-Mendez, Mary E.</creatorcontrib><creatorcontrib>Rhodin, Kristen E.</creatorcontrib><creatorcontrib>Vekstein, Andrew M.</creatorcontrib><creatorcontrib>Schuyler Jones, W.</creatorcontrib><creatorcontrib>Rymer, Jennifer A.</creatorcontrib><creatorcontrib>Zwischenberger, Brittany A.</creatorcontrib><creatorcontrib>Williams, Adam R.</creatorcontrib><title>Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection</title><title>Seminars in thoracic and cardiovascular surgery</title><addtitle>Semin Thorac Cardiovasc Surg</addtitle><description>[Display omitted]
Spontaneous coronary artery dissection (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome. Indications for revascularization and long-term outcomes of SCAD remain areas of active investigation. We report our experience with initial management strategy and long-term outcomes in SCAD. We reviewed all patients treated at our institution from 1996-2021 with a SCAD diagnosis. Demographics, comorbidities, clinical presentations, angiography findings, and management strategies were obtained by chart review. The primary outcome was a composite of cardiac death, recurrent/progressive SCAD, subsequent diagnosis of congestive heart failure, or subsequent/repeat revascularization after the initial management. Unadjusted Kaplan-Meier survival analysis was performed. Of 186 patients with a SCAD diagnosis treated at our institution, 149 (80%) were female. Medical management was the initial treatment in 134 (72.0%) patients, percutaneous coronary intervention (PCI) in 43 (23.1%), and coronary artery bypass grafting in 9 (4.8%). Surgery/PCI intervention was associated with younger age (38.8 vs 47.7 years, P = 0.01), ST elevation myocardial infarction on presentation (67.0% vs 34.0%, P < 0.001), lower ejection fraction (45.0% vs 55.0%, P = 0.002), and left anterior descending coronary artery dissection (75.0% vs 51.0%, P = 0.006). Ten-year freedom from our composite outcome was similar between revascularized patients and those managed with medical therapy (P = 0.36). Median follow-up time was 4.5 years. SCAD in the setting of ST elevation myocardial infarction, left anterior descending coronary artery involvement, or decreased cardiac function suggests greater ischemic insult and was associated with initial percutaneous or surgical revascularization. Despite worse disease on initial presentation, long-term outcomes of patients undergoing revascularization are similar to medically managed patients with SCAD.</description><subject>Adult</subject><subject>CABG</subject><subject>Cardiovascular Agents - therapeutic use</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary Artery Bypass - mortality</subject><subject>Coronary Vessel Anomalies - complications</subject><subject>Coronary Vessel Anomalies - diagnostic imaging</subject><subject>Coronary Vessel Anomalies - mortality</subject><subject>Coronary Vessel Anomalies - surgery</subject><subject>Coronary Vessel Anomalies - therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial infarction</subject><subject>PCI</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - mortality</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>SCAD</subject><subject>Spontaneous coronary artery dissection</subject><subject>STEMI</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular Diseases - congenital</subject><subject>Vascular Diseases - diagnostic imaging</subject><subject>Vascular Diseases - mortality</subject><subject>Vascular Diseases - physiopathology</subject><subject>Vascular Diseases - surgery</subject><subject>Vascular Diseases - therapy</subject><issn>1043-0679</issn><issn>1532-9488</issn><issn>1532-9488</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkMtu2zAQRYmgQd6f0ILLbqQMRVEiV0Xg5gU4yCLJmqCokUHDIl2SDpC_LwM73XZ1Z4A7c2cOId8Z1AwEv17XCeds31PdQMNrEDUAOyJnTPCmUq2U30oNLa-g69UpOU9pDdCwnvMTcsr7jvOu4WfEPXqXndnQJ-PNCmf0mb7kaDKuPqjxI10Gv6peMc70eZdtmDFR5ymTHV2YVJow0Zdt8Nl4DLtEFyEGb-IHvYkZi_x2KaHNLvhLcjyZTcKrg16Qt7vb18VDtXy-f1zcLCvLWceq3oAaTCvUNFijmkZxY9UwSaVQ2pEDdJPFTrQjCCOtYhxGZMxM09ArMJ3hF-Tnfu82hj87TFnPLlncbPYX6kaKXrYKWlmsYm-1MaQUcdLb6OZyvWagPynrtT5Q1p-UNQhdKJe5H4eI3TDj-G_qC2sx_NobsDz67jDqZB16i6OLhYYeg_tPxF9dDZGm</recordid><startdate>2024</startdate><enddate>2024</enddate><creator>Jensen, Christopher W.</creator><creator>Kang, Lillian</creator><creator>Moya-Mendez, Mary E.</creator><creator>Rhodin, Kristen E.</creator><creator>Vekstein, Andrew M.</creator><creator>Schuyler Jones, W.</creator><creator>Rymer, Jennifer A.</creator><creator>Zwischenberger, Brittany A.</creator><creator>Williams, Adam R.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2024</creationdate><title>Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection</title><author>Jensen, Christopher W. ; Kang, Lillian ; Moya-Mendez, Mary E. ; Rhodin, Kristen E. ; Vekstein, Andrew M. ; Schuyler Jones, W. ; Rymer, Jennifer A. ; Zwischenberger, Brittany A. ; Williams, Adam R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3161-7a09ba459fbca92293ac9bf899e8cd3006fce654d05a8c9130de11affb790a6a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>CABG</topic><topic>Cardiovascular Agents - therapeutic use</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Coronary Artery Bypass - mortality</topic><topic>Coronary Vessel Anomalies - complications</topic><topic>Coronary Vessel Anomalies - diagnostic imaging</topic><topic>Coronary Vessel Anomalies - mortality</topic><topic>Coronary Vessel Anomalies - surgery</topic><topic>Coronary Vessel Anomalies - therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial infarction</topic><topic>PCI</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Percutaneous Coronary Intervention - mortality</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>SCAD</topic><topic>Spontaneous coronary artery dissection</topic><topic>STEMI</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular Diseases - congenital</topic><topic>Vascular Diseases - diagnostic imaging</topic><topic>Vascular Diseases - mortality</topic><topic>Vascular Diseases - physiopathology</topic><topic>Vascular Diseases - surgery</topic><topic>Vascular Diseases - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jensen, Christopher W.</creatorcontrib><creatorcontrib>Kang, Lillian</creatorcontrib><creatorcontrib>Moya-Mendez, Mary E.</creatorcontrib><creatorcontrib>Rhodin, Kristen E.</creatorcontrib><creatorcontrib>Vekstein, Andrew M.</creatorcontrib><creatorcontrib>Schuyler Jones, W.</creatorcontrib><creatorcontrib>Rymer, Jennifer A.</creatorcontrib><creatorcontrib>Zwischenberger, Brittany A.</creatorcontrib><creatorcontrib>Williams, Adam R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Seminars in thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jensen, Christopher W.</au><au>Kang, Lillian</au><au>Moya-Mendez, Mary E.</au><au>Rhodin, Kristen E.</au><au>Vekstein, Andrew M.</au><au>Schuyler Jones, W.</au><au>Rymer, Jennifer A.</au><au>Zwischenberger, Brittany A.</au><au>Williams, Adam R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection</atitle><jtitle>Seminars in thoracic and cardiovascular surgery</jtitle><addtitle>Semin Thorac Cardiovasc Surg</addtitle><date>2024</date><risdate>2024</risdate><volume>36</volume><issue>4</issue><spage>387</spage><epage>397</epage><pages>387-397</pages><issn>1043-0679</issn><issn>1532-9488</issn><eissn>1532-9488</eissn><abstract>[Display omitted]
Spontaneous coronary artery dissection (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome. Indications for revascularization and long-term outcomes of SCAD remain areas of active investigation. We report our experience with initial management strategy and long-term outcomes in SCAD. We reviewed all patients treated at our institution from 1996-2021 with a SCAD diagnosis. Demographics, comorbidities, clinical presentations, angiography findings, and management strategies were obtained by chart review. The primary outcome was a composite of cardiac death, recurrent/progressive SCAD, subsequent diagnosis of congestive heart failure, or subsequent/repeat revascularization after the initial management. Unadjusted Kaplan-Meier survival analysis was performed. Of 186 patients with a SCAD diagnosis treated at our institution, 149 (80%) were female. Medical management was the initial treatment in 134 (72.0%) patients, percutaneous coronary intervention (PCI) in 43 (23.1%), and coronary artery bypass grafting in 9 (4.8%). Surgery/PCI intervention was associated with younger age (38.8 vs 47.7 years, P = 0.01), ST elevation myocardial infarction on presentation (67.0% vs 34.0%, P < 0.001), lower ejection fraction (45.0% vs 55.0%, P = 0.002), and left anterior descending coronary artery dissection (75.0% vs 51.0%, P = 0.006). Ten-year freedom from our composite outcome was similar between revascularized patients and those managed with medical therapy (P = 0.36). Median follow-up time was 4.5 years. SCAD in the setting of ST elevation myocardial infarction, left anterior descending coronary artery involvement, or decreased cardiac function suggests greater ischemic insult and was associated with initial percutaneous or surgical revascularization. Despite worse disease on initial presentation, long-term outcomes of patients undergoing revascularization are similar to medically managed patients with SCAD.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37633623</pmid><doi>10.1053/j.semtcvs.2023.05.001</doi><tpages>11</tpages></addata></record> |
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| ispartof | Seminars in thoracic and cardiovascular surgery, 2024, Vol.36 (4), p.387-397 |
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| subjects | Adult CABG Cardiovascular Agents - therapeutic use Coronary Angiography Coronary Artery Bypass - adverse effects Coronary Artery Bypass - mortality Coronary Vessel Anomalies - complications Coronary Vessel Anomalies - diagnostic imaging Coronary Vessel Anomalies - mortality Coronary Vessel Anomalies - surgery Coronary Vessel Anomalies - therapy Female Humans Male Middle Aged Myocardial infarction PCI Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - mortality Recurrence Retrospective Studies Risk Assessment Risk Factors SCAD Spontaneous coronary artery dissection STEMI Time Factors Treatment Outcome Vascular Diseases - congenital Vascular Diseases - diagnostic imaging Vascular Diseases - mortality Vascular Diseases - physiopathology Vascular Diseases - surgery Vascular Diseases - therapy |
| title | Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection |
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