What question did this study set out to answer?

To evaluate predisposing factors, precipitating triggers, angiographic features, and cardiovascular outcomes in patients presenting with nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD).

October 1, 2014Circulation Cardiovascular Interventions

Spontaneous Coronary Artery Dissection

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Key result

Nonatherosclerotic SCAD is linked to FMD in 72% of patients.

Population

168 patients with nonatherosclerotic spontaneous coronary artery dissection evaluated at Vancouver General…

Design

Cohort

Follow-up

Median 6.9 years in the retrospective cohort and 0.8 years…

Authors

JSJacqueline SawInterventional / Structural Cardiology EAEve AymongInterventional Cardiology TSTara SedlakGeneral Cardiology

Discussion

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Implication

Supports FMD screening in SCAD; extends observational links but leaves optimal management open.

Key Points

To evaluate predisposing factors, precipitating triggers, angiographic features, and cardiovascular outcomes in patients presenting with nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD).
Prospective evaluation of N=168 patients presenting with NA-SCAD confirmed and categorized angiographically (type 1, 2, or 3) by two interventional cardiologists at Vancouver General Hospital.
Screening for extra-coronary fibromuscular dysplasia in renal, iliac, and cerebrovascular beds using catheter angiography, computed tomographic angiography, or magnetic resonance angiography.
Documentation of in-hospital interventions (conservative management, percutaneous coronary intervention, or coronary artery bypass grafting) and tracking of 2-year major adverse cardiac events.
Among 168 patients (92.3% women, mean age 52.1±9.2 years, 100% presenting with myocardial infarction), 72.0% were diagnosed with fibromuscular dysplasia, 56.5% reported emotional or physical stress triggers, and 67.0% displayed type 2 angiographic dissection.
Conservative therapy was initially employed in 134 of 168 patients; 3 required subsequent revascularization for dissection extension, and 100% (79 of 79) of those with repeat angiography at ≥26 days demonstrated spontaneous arterial healing.
Major adverse cardiac events at 2 years occurred in 16.9% of the retrospective group and 10.4% of the prospective group, with recurrent spontaneous coronary artery dissection occurring in 13.1% overall.

Structured PICO

Population

168 patients with nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) evaluated at Vancouver General Hospital (48 retrospectively identified, 120 prospectively identified). Mean age 52.1 years, 92.3% women (62.3% postmenopausal). All presented with myocardial infarction.

Intervention

Observational cohort assessing predisposing conditions (e.g., fibromuscular dysplasia), precipitating stressors, angiographic characteristics, and management strategies (conservative therapy vs. percutaneous coronary intervention or coronary artery bypass surgery).

Outcome

In-hospital events, long-term major adverse cardiac events (MACE), and angiographic healing at follow-up.hard clinical

NA-SCAD predominantly affects women, is strongly associated with fibromuscular dysplasia, and conservative management is viable and associated with spontaneous angiographic healing, whereas PCI carries a high risk of complications.

Cite This Study

Saw et al. (2014) studied this question. In patients with nonatherosclerotic spontaneous coronary artery dissection, 72% had fibromuscular dysplasia and 67% had type 2 SCAD, with a two-year major adverse cardiac event rate of 10.4%.

synapsesocial.com/papers/69898a05810bd1b401d0af85 https://doi.org/10.1161/circinterventions.114.001760

Topics

Percutaneous coronary intervention

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Spontaneous Coronary Artery Dissection

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Spontaneous Coronary Artery Dissection

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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