Abstract
Background
Nonatherosclerotic coronary artery disease (NACAD) is an important cause of myocardial
infarction (MI) in young women but is often missed on coronary angiography, especially
spontaneous coronary artery dissection (SCAD). The prevalence of NACAD in young women
has not been described.
Methods
We retrospectively reviewed all coronary angiograms of women aged 50 years and younger
at Vancouver General Hospital from December 1, 2009 to November 30, 2011. The angiograms
were reviewed by 2 experienced interventional cardiologists, and reported as normal
(<30% stenosis), atherosclerotic coronary artery disease (ACAD), or NACAD. NACAD was
further characterized as SCAD, coronary fibromuscular dysplasia (FMD), ectasia, vasculitis,
embolism, congenital anomaly, or unclear etiology.
Results
Of 7605 coronary angiograms performed, 177 were done in women aged 50 years and younger.
The mean age was 45.4 ± 4.9 (range, 31-50) years, 76 of 177 (42.9%) presented with
acute coronary syndrome, and 66 were troponin-positive. Ninety-seven (54.8%) women
had normal arteries, 54 (30.5%) had ACAD, 23 (13.0%) had NACAD, and 3 (1.7%) had unclear
etiology. Of those with NACAD, SCAD was observed in 16 (all troponin-positive and
13 of 16 had noncoronary FMD), and 2 had irregular beading suspicious of coronary
FMD. Coronary vasculitis was suspected in 2, and 5 had coronary ectasia. Among women
with MI (66/177), 19 (28.8%) had normal arteries (3 Takotsubo cardiomyopathy), 24
(36.4%) had ACAD, 20 (30.3%) had NACAD, 16 (24.2%) had SCAD, and 3 had unclear etiology.
Conclusions
NACAD was not rare among young women (aged 50 years and younger) undergoing coronary
angiography and was an important cause of MI, accounting for 30%. SCAD was the most
commonly encountered NACAD in young women, causing 24% of MIs.
Résumé
Introduction
La disease non athéroscléreuse de l’artère coronaire (DNAAC) qui est une cause importante
d’infarctus du myocarde (IM) chez les jeunes femmes passe souvent inaperçue à l’angiographie
coronarienne, et ce, particulièrement dans le cas de dissection spontanée de l’artère
coronaire (DSAC). La prévalence de la DNAAC chez les jeunes femmes n’a pas été décrite.
Méthodes
Nous avons passé en revue de manière rétrospective tous les angiogrammes coronariens
de femmes de 50 ans et moins du Vancouver General Hospital du 1er décembre 2009 au 30 novembre 2011. Les angiogrammes ont été revus par 2 cardiologues
expérimentés en cardiologie interventionnelle, et ont été rapportés comme étant normaux
(sténose < 30 %), montrant une disease athéroscléreuse de l’artère coronaire (DAAC)
ou une DNAAC. La DNAAC a davantage été classifiée comme étant une DSAC, une dysplasie
fibromusculaire coronarienne (DFC), une ectasie, une vascularite, une embolie, une
anomalie congénitale ou d’étiologie incertaine.
Résultats
Parmi les 7605 angiogrammes coronariens réalisés, 177 ont été subis par des femmes
de 50 ans et moins. L’âge moyen était de 45,4 ± 4,9 (étendue, 31-50) ans, 76 des 177
(42,9 %) femmes présentaient un syndrome coronarien aigu, et 66 montraient une troponine
positive. Quatre-vingt-dix-sept (97; 54,8 %) femmes avaient des artères normales,
54 (30,5 %) avaient une DAAC, 23 (13,0 %) avaient une DNAAC et 3 (1,7 %) étaient d’étiologie
incertaine. Parmi celles ayant une DNAAC, une DSAC a été observée chez 16 d’entre
elles (toutes montrant une troponine positive et 13 parmi les 16 avaient une DFC non
coronarienne), et 2 avaient l’aspect irrégulier de collier de perles de la DFC coronarienne.
La vascularite coronarienne a été suspectée chez 2 femmes, et 5 avaient une ectasie
coronarienne. Parmi les femmes ayant un IM (66/177), 19 (28,8 %) avaient des artères
normales (3 cardiomyopathies de Takotsubo), 24 (36,4 %) avaient une DAAC, 20 (30,3
%) avaient une DNAAC, 16 (24,2 %) avaient une DSAC, et 3 étaient d’étiologie incertaine.
Conclusions
La DNAAC n’était pas rare chez les jeunes femmes (de 50 ans et moins) subissant l’angiographie
coronarienne et était une cause importante d’IM, qui s’élevait à 30 %. La DSAC était
la DNAAC la plus fréquemment observée chez les jeunes femmes, causant 24 % des IM.
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Article info
Publication history
Published online: January 27, 2014
Accepted:
January 16,
2014
Received:
September 27,
2013
Footnotes
See page 818 for disclosure information.
Identification
Copyright
© 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
