Abstract
Background
Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial
infarction (MI). However, the role of revascularization for SCAD according to presentation
remains unclear.
Methods
We analyzed SCAD patients who presented acutely participating in the Canadian SCAD
Cohort Study. We compared revascularization strategy and clinical outcomes (in-hospital
major adverse events and major adverse cardiovascular event [MACE] including recurrent
MI at 1-year) in SCAD patients presenting with ST-elevation MI (STEMI) vs. unstable
angina or non-STEMI (UA/NSTEMI).
Results
Among 750 SCAD patients (mean 51.7±10.5years; 88.5% were women; median follow-up was
373 days), 234 (31.2%) presented with STEMI. More SCAD-STEMI patients (27.8%) were
treated with revascularization (98.5% PCI) compared to 8.7% of UA/NSTEMI patients
(93.3% PCI). For SCAD-STEMI patients, 93.9% were planned procedures versus 71.1% for
UA/NSTEMI. Successful or partially successful PCI was 65.5% for STEMI and 76.9% for
UA/NSTEMI (p<0.001). In revascularized patients, 1-year MACE was not different between
STEMI and UA-NSTEMI. Revascularization was associated with higher in-hospital major
adverse events and its association was more prominent in UA/NSTEMI (STEMI: 26.2% vs.
10.7%, p<0.001; UA/NSTEMI: 37.8% vs. 3.6%, p<0.001). The difference in adverse events
according to revascularization diminished over time and was not evident at 1-year.
Conclusions
Despite higher in-hospital events with revascularization in SCAD patients, and higher
revascularization with SCAD-STEMI, 1-year MACE was not different compared to UA/NSTEMI.
This is reassuring since revascularization may be required for ongoing ischemia at
the time of initial presentation in STEMI-SCAD, and emphasizes the need for careful
patient selection for revascularization in UA/NSTEMI.
Keywords
List of Abbreviations:
SCAD (Spontaneous coronary artery dissection), MI (Myocardial infarction), PCI (Percutaneous coronary intervention), UA/NSTEMI (Unstable angina and non-ST-elevation MI), TIMI (Thrombolysis in myocardial infarction), MAE (Major adverse events), TIA (Transient ischemic attack), MACE (Major adverse cardiovascular events), VF/VT (Ventricular fibrillation or ventricular tachycardia), LMT (Left main trunk), LAD (Left anterior descending artery)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
July 5,
2022
Received in revised form:
June 23,
2022
Received:
March 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Brief Summary
In this registry-based cohort study of spontaneous coronary artery dissection (SCAD) patients, we evaluated the role of revascularization for SCAD according to presentation (STEMI vs. UA/NSTEMI). Despite higher in-hospital events with revascularization, and higher revascularization with SCAD-STEMI, 1-year major adverse cardiovascular event-rate was not different compared to UA/NSTEMI. This is reassuring since revascularization may be required for ongoing ischemia at the time of presentation in STEMI-SCAD, and emphasizes the need for careful patient selection for revascularization in UA/NSTEMI.
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
