Percutaneous coronary intervention for SCAD showed high procedural failure rates (53%) and offered no benefit over conservative management in preventing recurrent SCAD.
Does initial revascularization (PCI or CABG) improve early and long-term clinical outcomes compared to conservative therapy in patients presenting with a first episode of spontaneous coronary artery dissection?
Routine percutaneous coronary intervention for spontaneous coronary artery dissection is associated with high technical failure rates and does not improve long-term outcomes, suggesting conservative management should be the preferred initial strategy.
Tasa de eventos absoluta: 0% vs 0%
Background— Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic acute coronary syndrome for which optimal management remains undefined. Methods and Results— We performed a retrospective study of 189 patients presenting with a first SCAD episode. We evaluated outcomes according to initial management: (1) revascularization versus conservative therapy and (2) percutaneous coronary intervention (PCI) versus conservative therapy stratified by vessel flow at presentation. Demographics were similar in revascularization versus conservative (mean age, 44±9 years; women 92% both groups), but vessel occlusion was more frequent in revascularization (44/95 versus 18/94). There was 1 in-hospital death (revascularization) and 1 late death (conservative). Procedural failure rate was 53% in those managed with PCI. In the subgroup of patients presenting with preserved vessel flow, rates of PCI failure were similarly high (50%), and 6 (13%) required emergency coronary artery bypass grafting. In the conservative group, 85 of 94 (90%) had an uneventful in-hospital course, but 9 (10%) experienced early SCAD progression requiring revascularization. Kaplan–Meier estimated 5-year rates of target vessel revascularization and recurrent SCAD were no different in revascularization versus conservative therapy (30% versus 19%; P =0.06 and 23% versus 31%; P =0.7). Conclusions— PCI for SCAD is associated with high rates of technical failure even in those presenting with preserved vessel flow and does not protect against target vessel revascularization or recurrent SCAD. A strategy of conservative management with prolonged observation may be preferable.
Tweet et al. (Wed,) reported a other. Percutaneous coronary intervention for SCAD showed high procedural failure rates (53%) and offered no benefit over conservative management in preventing recurrent SCAD.