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November 19, 2014Circulation Cardiovascular InterventionsOpen Access

Spontaneous Coronary Artery Dissection

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Key result

PCI for SCAD fails in 53% of procedures and offers no benefit over conservative management.

Why the study?

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?

Population

189 patients presenting with a first episode of spontaneous coronary artery dissection at Mayo Clinic…

Comparison

Initial revascularization strategy. vs Conservative therapy.

Design

Cohort

Follow-up

median 2.3 years

Authors

MTMarysia S. TweetGeneral CardiologyMEMackram F. EleidInterventional CardiologyPBPatricia J.M. BestInterventional / Structural Cardiology

Discussion

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Member takes

Overview

PCI failure common without outcome benefit in SCAD; challenges variable strategies and leaves open randomized confirmation.

Structured PICO

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?

P
Population
189 patients presenting with a first episode of spontaneous coronary artery dissection (SCAD) at Mayo Clinic between 1984 and 2014. Mean age 44±9 years, 92% women.
I
Intervention
Initial revascularization strategy (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]).
C
Comparator
Conservative therapy (prolonged observation and medical management).
O
Outcome
Early outcomes (in-hospital mortality, urgent/emergent CABG, PCI procedural failure) and late outcomes (5-year rates of target vessel revascularization [TVR] and recurrent SCAD).hard clinical

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.

Limitations

  • Retrospective design
  • Single-center study
  • Selection bias in treatment assignment (patients with STEMI or vessel occlusion more likely to receive revascularization)

Cite This Study

Tweet et al. (2014) studied this question. Percutaneous coronary intervention for SCAD showed high procedural failure rates (53%) and offered no benefit over conservative management in preventing recurrent SCAD.

synapsesocial.com/papers/69898a06e91dc482c51abdcchttps://doi.org/10.1161/circinterventions.114.001659

Topics

Percutaneous coronary interventionChronic total occlusion PCI
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Also Consider

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