1. Canadian Spontaneous Coronary Artery Dissection Cohort Study: 3-Year Outcomes.
- Author
-
Saw, Jacqueline, Starovoytov, Andrew, Aymong, Eve, Inohara, Taku, Alfadhel, Mesfer, McAlister, Cameron, Samuel, Rohit, Grewal, Tejana, Parolis, Johandra Argote, Sheth, Tej, So, Derek, Minhas, Kunal, Brass, Neil, Lavoie, Andrea, Bishop, Helen, Lavi, Shahar, Pearce, Colin, Renner, Suzanne, Madan, Mina, and Welsh, Robert C.
- Subjects
- *
SPONTANEOUS coronary artery dissection , *ST elevation myocardial infarction , *MAJOR adverse cardiovascular events , *CORONARY artery bypass , *PERCUTANEOUS coronary intervention , *ARTERIAL occlusions , *PATIENT aftercare , *RESEARCH , *RESEARCH methodology , *MYOCARDIAL infarction , *EVALUATION research , *CORONARY angiography , *COMPARATIVE studies , *ASPIRIN , *RESEARCH funding , *CORONARY arteries , *DISCHARGE planning , *LONGITUDINAL method , *DISEASE complications - Abstract
Background: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in young to middle-aged women.Objectives: We aim to define the long-term natural history of SCAD.Methods: We performed a multicenter, prospective, observational study of patients with nonatherosclerotic SCAD presenting acutely from 22 North American centers. We recorded baseline demographics, in-hospital characteristics, precipitating and predisposing conditions, angiographic features (adjudicated), in-hospital and 3-year major adverse cardiovascular events (MACE). Cox regression multivariable analysis was performed.Results: We prospectively enrolled 750 consecutive patients with SCAD from June 2014 to June 2018. Mean age was 51.7 ± 10.5 years, 88.5% were women (55.0% postmenopausal); 31.3% presented with ST-segment elevation myocardial infarction, and 68.3% with non-ST-segment elevation myocardial infarction. Precipitating emotional stressor was reported in 50.3%, and physical stressor in 28.9%. Predisposing conditions included fibromuscular dysplasia in 42.9% (56.4% in those with complete screening), peripartum state 4.5%, and genetic disorders 1.6%. Most patients were treated conservatively (84.3%); 14.1% underwent percutaneous coronary intervention (PCI), 0.7% coronary artery bypass graft. At 3.0-year median follow-up, mortality was 0.8%, recurrent MI 9.9% (extension of previous SCAD 3.5%, de novo recurrent SCAD 2.4%, iatrogenic dissection 1.9%), with overall MACE 14.0%. Presence of genetic disorders, peripartum SCAD, and extracoronary fibromuscular dysplasia were independent predictors of 3-year MACE. Patients who underwent PCI at index hospitalization had similar postdischarge MACE compared with no PCI. At 3 years, 80.0% remained on aspirin and 73.5% on beta-blockade.Conclusions: Long-term mortality and de novo recurrent SCAD was low in our contemporary large SCAD cohort that included low revascularization rate and high use of beta-blockade and aspirin. Genetic disorders, extracoronary fibromuscular dysplasia, and peripartum SCAD were independent predictors of long-term MACE. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF