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. 2022 Dec;100(7):1229-1241.
doi: 10.1002/ccd.30448. Epub 2022 Oct 23.

Revascularization and long-term outcomes in high-acuity spontaneous coronary artery dissection

Christina Thaler  1 , Dawn R Witt  1 , Timothy D Henry  2 , Elizabeth Z Grey  1 , Courtney J Baechler  1 , Opema Lohese  1 , Brynn K Okeson  1 , Christian W Schmidt  1 , Scott W Sharkey  1
Affiliations

Revascularization and long-term outcomes in high-acuity spontaneous coronary artery dissection

Christina Thaler et al. Catheter Cardiovasc Interv. 2022 Dec.

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is often treated conservatively due to revascularization risks. Yet, an important number of SCAD patients have high acuity characteristics necessitating revascularization, with uncertain long-term outcomes.

Objectives: Document revascularization utilization and long-term outcomes in high acuity SCAD.

Methods: Prospective/retrospective analysis of consecutive patients with acute myocardial infarction (AMI) due to first SCAD event presenting directly to the Minneapolis Heart Institute 2002-2021, median follow-up 3.8 years.

Results: Among 139 patients (age 49 ± 12 years, 96% female), revascularization was performed in 60 (43%), utilizing percutaneous coronary intervention (PCI) (n = 56, successful in 80%) or coronary artery bypass graft (n = 4). In the entire cohort, 90 (65%) unique patients had one or more high acuity characteristic: ST-elevation (38%), proximal dissection (38%), cardiogenic shock (6.5%), cardiac arrest (9.4%), left main dissection (6.5%), peripartum dissection (7.2%). High acuity patients accounted for 51 of 60 (85%) revascularizations. Revascularization rates were: ST-elevation (60%), proximal dissection (62%), cardiogenic shock (89%), cardiac arrest (62%), left main dissection (100%), peripartum dissection (70%). Survival was 97% (revascularized) vs 100% (nonrevascularized); p = 0.2. Adverse outcomes (revascularized vs. nonrevascularized) included recurrent AMI:16.7% versus 8.9%; p = 0.2, SCAD recurrence: 13.3% versus 6.3%; p = 0.1, stroke: 5% versus 2.5%; p = 0.44, implantable cardioverter-defibrillator: 6.7% versus 6.3%; p > 0.9. Reintervention was necessary in 21% of PCI-treated patients.

Conclusions: High-acuity characteristics were present in nearly two-thirds of this SCAD cohort; the vast majority of revascularizations were performed in high-acuity patients. Despite high acuity, long-term survival was favorable in revascularized patients.

Keywords: SCAD; STEMI; cardiac arrest; cardiogenic shock; coronary dissection; left main dissection.

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References

REFERENCES

    1. Saw J, Mancini GBJ, Humphries KH. Contemporary review on spontaneous coronary artery dissection. J Am Coll Cardiol. 2016;68:297-312.
    1. Tweet MS, Hayes SN, Pitta SR, et al. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012;126:579-588.
    1. Hayes SN, Tweet MS, Adlam D, et al. Spontaneous coronary artery dissection: JACC State-of-the-Art review. J Am Coll Cardiol. 2020;76:961-984.
    1. Kim ESH. Spontaneous coronary-artery dissection. N Engl J Med. 2020;383:2358-2370.
    1. Adlam D, Alfonso F, Maas A, Vrints C, Writing Committee. European society of cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018;39:3353-3368.

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