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Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence.

Authors :
Saw, Jacqueline
Humphries, Karin
Aymong, Eve
Sedlak, Tara
Prakash, Roshan
Starovoytov, Andrew
Mancini, G.B. John
Source :
Journal of the American College of Cardiology (JACC). Aug2017, Vol. 70 Issue 9, p1148-1158. 11p.
Publication Year :
2017

Abstract

<bold>Background: </bold>Spontaneous coronary artery dissection (SCAD) is underdiagnosed and an important cause of myocardial infarction (MI), especially in young women. Long-term cardiovascular outcomes, including recurrent SCAD, are inadequately reported.<bold>Objectives: </bold>This study sought to describe the acute and long-term cardiovascular outcomes and assess the predictors of recurrent SCAD.<bold>Methods: </bold>Nonatherosclerotic SCAD patients were prospectively followed at Vancouver General Hospital systematically to ascertain baseline, predisposing and precipitating stressors, angiographic features, revascularization, use of medication, and in-hospital and long-term cardiovascular events. Clinical predictors for recurrent de novo SCAD were tested using univariate and multivariate Cox regression models.<bold>Results: </bold>The authors prospectively followed 327 SCAD patients. Average age was 52.5 ± 9.6 years, and 90.5% were women (56.9% postmenopausal). All presented with MI; 25.7% had ST-segment elevation MI, 74.3% had non-ST-segment elevation MI, and 8.9% had ventricular tachycardia/ventricular fibrillation. Precipitating emotional stressors were reported in 48.3% and physical stressors in 28.1%. Fibromuscular dysplasia was present in 62.7%, connective tissue disorder in 4.9%, and systemic inflammatory disease in 11.9%. The majority (83.1%) were initially treated medically, with only 16.5% or 2.2% undergoing in-hospital percutaneous coronary intervention or coronary artery bypass graft surgery, respectively. The majority of SCAD patients were taking aspirin and beta-blocker therapy at discharge and at follow-up. Median hospital stay was 3.0 days, and the overall major adverse event rate was 7.3%. Median long-term follow-up was 3.1 years, and overall major adverse cardiac event rate was 19.9% (death rate: 1.2%; recurrent MI: 16.8%; stroke/transient ischemic attack: 1.2%; revascularization: 5.8%). Recurrent SCAD occurred in 10.4% of patients. In multivariate modeling, only hypertension increased (hazard ratio: 2.46; p = 0.011) and beta-blocker use diminished (hazard ratio: 0.36; p = 0.004) recurrent SCAD.<bold>Conclusions: </bold>In our large prospectively followed SCAD cohort, long-term cardiovascular events were common. Hypertension increased the risk of recurrent SCAD, whereas beta-blocker therapy appeared to be protective. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
07351097
Volume :
70
Issue :
9
Database :
Academic Search Index
Journal :
Journal of the American College of Cardiology (JACC)
Publication Type :
Academic Journal
Accession number :
124606542
Full Text :
https://doi.org/10.1016/j.jacc.2017.06.053