Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection

The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134...

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Published in:The American journal of cardiology 2015-07, Vol.116 (1), p.66-73
Main Authors: Lettieri, Corrado, MD, Zavalloni, Dennis, MD, Rossini, Roberta, MD, PhD, Morici, Nuccia, MD, Ettori, Federica, MD, Leonzi, Ornella, MD, Latib, Azeem, MD, Ferlini, Marco, MD, Trabattoni, Daniela, MD, Colombo, Paola, MD, Galli, Mario, MD, Tarantini, Giuseppe, MD, PhD, Napodano, Massimo, MD, Piccaluga, Emanuela, MD, Passamonti, Enrico, MD, Sganzerla, Paolo, MD, Ielasi, Alfonso, MD, Coccato, Micol, MD, Martinoni, Alessandro, MD, Musumeci, Giuseppe, MD, Zanini, Roberto, MD, Castiglioni, Battistina, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Angioplasty
Biomarkers
Cardiology
Cardiovascular
Cardiovascular disease
Confidence intervals
Coronary Angiography
Coronary Artery Bypass - methods
Coronary Vessel Anomalies - diagnostic imaging
Coronary Vessel Anomalies - mortality
Coronary Vessel Anomalies - surgery
Coronary vessels
Dissection
Electrocardiography
Female
Follow-Up Studies
Heart attacks
Heart failure
Humans
Ischemia
Italy
Male
Medical records
Middle Aged
Percutaneous Coronary Intervention - methods
Prognosis
Prospective Studies
Retrospective Studies
Standard deviation
Stroke
Success
Survival Analysis
Thrombosis
Treatment Outcome
Variables
Vascular Diseases - congenital
Vascular Diseases - diagnostic imaging
Vascular Diseases - mortality
Vascular Diseases - surgery
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Description
Summary:The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 ± 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2015.03.039