In a retrospective series of 12 women under age 60 with spontaneous coronary artery dissection, 11 survived with favorable long-term evolution after PCI (n=10) or conservative therapy (n=2).
Observational (n=12)
No
What are the outcomes of different management strategies for spontaneous coronary artery dissection in young women?
In a series of 12 young women with SCAD, survival was high with a management strategy tailored to lesion extent and hemodynamic status, often involving PCI.
Spontaneous coronary artery dissection (SCAD) is a rare pathology, principally affecting young women free of atheroma risk factors. Its physiopathology remains little understood, and the prognosis for such acute coronary syndromes is poor, as they occur suddenly. Management is often difficult, and no guidelines exist. The present single-center retrospective study concerns 12 cases of SCAD occurring between 2001 and 2008 in female patients under the age of 60. Eleven patients survived, with a favorable long-term evolution. Only 2 had conservative medical therapy, the other 10 undergoing percutaneous coronary intervention (2 procedures involving a coronary artery bypass graft). On the basis of this series and data from the literature, we suggest a strategy to improve the often dire prognosis of SCAD. Emergency angiography to confirm diagnosis is essential. Treatment should be guided by the extent of the lesions, the myocardial ischemia and the hemodynamic status. Conservative medical therapy is a reasonable approach in the case of distal dissection or conserved coronary flow. Percutaneous coronary intervention is feasible in the acute phase to restore coronary perfusion and hemodynamic stability. Surgery - emergency bypass or assisted circulation - should be restricted to cases where percutaneous coronary intervention has failed or is impossible.
Motreff et al. (Wed,) conducted a observational in Spontaneous coronary artery dissection (SCAD) (n=12). Percutaneous coronary intervention or conservative medical therapy was evaluated on Survival. In a retrospective series of 12 women under age 60 with spontaneous coronary artery dissection, 11 survived with favorable long-term evolution after PCI (n=10) or conservative therapy (n=2).