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Abstract
Spontaneous coronary artery dissection is an infrequent cause of acute coronary syndrome with comparable clinical features. Previously considered a rare disease, recent scientific interest has revealed spontaneous coronary artery dissection as an important differential diagnosis of acute coronary syndrome, especially in young women, during pregnancy or postpartum, and in patients with fibromuscular dysplasia or other arteriopathies. However, there remain many uncertainties regarding pathophysiology, risk factors, acute treatment, and optimal long-term management. The aim of this review is to summarize current scientific evidence on epidemiology, management, and outcomes.
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Affiliation(s)
- Michael Würdinger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Christian Templin
- Andreas Grüntzig Heart Catheterization Laboratories, Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
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KANDEMİR HÜSEYİN, ÇELİK YUNUS, ŞABANOĞLU CENGİZ, GÜZEL MURAT, CİHAN GÖKHAN, AĞRALI ÖZKAN. A case of coronary vasospasm confused with atherosclerotic coronary artery disease. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2019. [DOI: 10.32322/jhsm.489598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abe T, Watanabe S, Mizuno A, Toyama M, Totten VY, Tokuda Y. A model for predicting angiographically normal coronary arteries in survivors of out-of-hospital cardiac arrest. J Intensive Care 2015; 3:32. [PMID: 26175896 PMCID: PMC4501276 DOI: 10.1186/s40560-015-0099-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/06/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND It has been recommended that all survivors of out-of-hospital cardiac arrest (OHCA) have immediate coronary angiography (CAG), even though it has been reported that half of the survivors have normal coronary arteries. Our aim was to develop a model which might identify those who have angiographically normal coronary arteries. Reliable prediction would reduce unnecessary CAG. METHODS A retrospective, observational, cohort study was conducted on 47 consecutive adult survivors who received immediate CAG after resuscitation from OHCA, between June 1, 2006 and March 31, 2011. We analyzed the clinical and electrocardiographic characteristics of the survivors with and without normal coronary arteries. RESULTS All subjects had CAG. Normal coronary arteries were found in 25/47. These persons did not have diabetes mellitus (p = 0.0069) or a history of acute coronary syndrome (ACS) (p = 0.0069). Any abnormality of the ST segment or ST segment elevation on electrocardiogram (ECG) was strongly related to abnormal coronary arteries (p = 0.0045 and p = 0.0200, respectively). The partitioning model for predicting angiographically normal coronary arteries showed that all patients (8/8) with no ST segment change on their ECG had normal coronary arteries. Eight out of ten patients with ST segment abnormalities also had normal coronary arteries with a history of arrhythmia without a history of ACS. CONCLUSIONS Survivors of OHCA who have no history of diabetes mellitus, who have no past history of ACS, and who present with no ST segment abnormalities may not require urgent/emergent CAG. Further studies are needed to guide clinicians in the determination of emergent cardiac catheterization following resuscitation of OHCA.
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Affiliation(s)
- Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Medical Center Hospital, 1-3-1, Amakubo, Tsukuba, Ibaraki 305-0005 Japan
| | - Shigeyuki Watanabe
- Department of Cardiology, Mito Kyodo General Hospital, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Masahiro Toyama
- Department of Cardiology, Mito Kyodo General Hospital, University of Tsukuba, Tsukuba, Ibaraki Japan
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Wilson RF. Coronary Angiography. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Navarro Valverde C, Núñez Gil I, Fernández Ortiz A. Síndrome coronario agudo y coronariografía sin lesiones significativas: ¿lo sabemos todo? Med Clin (Barc) 2013. [DOI: 10.1016/j.medcli.2012.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Mimics of acute coronary syndrome on MDCT. Emerg Radiol 2012; 20:235-42. [DOI: 10.1007/s10140-012-1097-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
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Chokshi NP, Iqbal SN, Berger RL, Hochman JS, Feit F, Slater JN, Pena-Sing I, Yatskar L, Keller NM, Babaev A, Attubato MJ, Reynolds HR. Sex and race are associated with the absence of epicardial coronary artery obstructive disease at angiography in patients with acute coronary syndromes. Clin Cardiol 2010; 33:495-501. [PMID: 20734447 DOI: 10.1002/clc.20794] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A substantial minority of patients with acute coronary syndromes (ACS) do not have a diameter stenosis of any major epicardial coronary artery on angiography ("no obstruction at angiography") of > or = 50%. We examined the frequency of this finding and its relationship to race and sex. HYPOTHESIS Among patients with myocardial infarction, younger age, female sex and non-white race are associated with the absence of obstructive coronary artery disease at angiography. METHODS We reviewed the results of all angiograms performed from May 19, 2006 to September 29, 2006 at 1 private (n = 793) and 1 public (n = 578) urban academic medical center. Charts were reviewed for indication and results of angiography, and for demographics. RESULTS The cohort included 518 patients with ACS. There was no obstruction at angiography in 106 patients (21%), including 48 (18%) of 258 patients with myocardial infarction. Women were more likely to have no obstruction at angiography than men, both in the overall cohort (55/170 women [32%] vs 51/348 men [15%], P < 0.001) and in the subset with MI (29/90 women [32%] vs 19/168 men [11%], P < 0.001). Black patients were more likely to have no obstruction at angiography relative to any other subgroup (24/66 [36%] vs 41/229 [18%] Whites, 31/150 [21%] Hispanics, and 5/58 [9%] Asians, P = 0.001). Among women, Black patients more frequently had no obstruction at angiography compared with other ethnic groups (16/27 [59%] vs 17/59 [29%] Whites, 17/60 [28%] Hispanics, and 3/19 [6%] Asians, P = 0.001). CONCLUSIONS A high proportion of a multiethnic sample of patients with ACS were found to have no stenosis > or = 50% in diameter at coronary angiography. This was particularly common among women and Black patients.
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Affiliation(s)
- Neel P Chokshi
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York, USA
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Ravel P, Marcaggi X, Ferrier N, Vignancour S, Clerfond G, Boch C, Amat G. [Myocardial infarction and ovarian stimulation: case report]. Ann Cardiol Angeiol (Paris) 2009; 58:313-317. [PMID: 19819419 DOI: 10.1016/j.ancard.2009.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Female infertility treated by ovarian stimulation can lead to arterial thrombosis particularly when ovarian hyperstimulation syndrome emerges. Myocardial infarction have been reported thrice, in one case even before artificial ovulation induction. A 25-year-old female with primary infertility underwent ovarian stimulation and eight days after ovulation induction and intra-uterine insemination suffered from a troponin positive non-ST-elevation myocardial infarction of the inferior wall. Coronary angiogram was normal and contrast-enhanced cardiovascular magnetic resonance imaging confirmed the subendocardial inferior infarct. This protocol included sole triptorelin administration followed by 23 recombinant follicle stimulating hormone injections and concluded by recombinant choriogonadotrophin. There was no ovarian hyperstimulation syndrome. Large biological screening did not retrieve any predisposition for arterial thrombosis. Clinical outcome was excellent. Despite weak causal link, we emphasize that chest pain during ovarian stimulation protocol should rise clinical concern for acute coronary syndrome.
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Affiliation(s)
- P Ravel
- Service de Réanimation, Centre Hospitalier de Vichy, Vichy, France
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Monassier JP, Jacquemin L, Roth O, LeBouar R, Kénizou D, Calatan A, Wiedemann JY, Moussaoui M, Diene L, Lévy J. [Non ST elevation acute coronary syndromes and normal coronary angiography: is it truly good news?]. Ann Cardiol Angeiol (Paris) 2008; 57:275-283. [PMID: 18930175 DOI: 10.1016/j.ancard.2008.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 08/27/2008] [Indexed: 05/26/2023]
Abstract
Among 10% of all patients presenting with non ST elevation acute coronary syndromes (ACS), coronary angiography do not show non lesions at all (50%) or mild atheromatous stenosis (50%). ACS without angiographic stenosis are more prevalent in female sex and young patients but can be seen in older ones and in men. Pathogenic mechanisms include acute evolution of vulnerable non-significant plaques and endothelial dysfunction. In hospital and mean term prognosis is not as benign as expected. Six months deaths and myocardial infarction incidence is around 6%. Numerous rehospitalizations due to ischemic recurrences are also very often seen. Therefore, such surprising coronary angiograms do not preclude a fair follow-up. These patients need a careful therapeutic strategy.
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Affiliation(s)
- J-P Monassier
- Service de cardiologie, hôpital Emile-Muller, 20, avenue du Dr-Laennec, 68070 Mulhouse, France.
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Dwyer JP, Redfern J, Freedman SB. Low utilisation of cardiovascular risk reducing therapy in patients with acute coronary syndromes and non-obstructive coronary artery disease. Int J Cardiol 2008; 129:394-8. [PMID: 18295912 DOI: 10.1016/j.ijcard.2007.12.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/11/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Between 6-25% of patients undergoing coronary angiography for acute coronary syndrome (ACS) have non-obstructive coronary artery disease (NOCAD). METHODS One-hundred and eighty patients presenting with an ACS who were taking part in a risk factor modification study and had undergone coronary angiography were examined. We compared baseline characteristics, medical treatment and 12-month outcome in patients with NOCAD (<50% lumen diameter stenosis at coronary angiography) and obstructive CAD (> or = 50% lumen diameter stenosis at coronary angiography). RESULTS There were 29 (16%) patients with NOCAD and 151 (84%) with obstructive CAD (CAD). Patients with NOCAD were significantly younger, more likely to be female, had higher mean total cholesterol and LDL levels, and fewer received cardiac rehabilitation, treatment with statins, aspirin, ACE inhibitors, beta-blockers or clopidogrel. Over the next 12-months, there was no mortality or myocardial infarction in the NOCAD group compared to 2% in the CAD group, but 14% with NOCAD were readmitted for a cardiovascular cause including 2 patients (7%) who underwent percutaneous coronary intervention (PCI). CONCLUSIONS Patients presenting with ACS and NOCAD may not have a completely benign prognosis, and preventative strategies and therapies such as statins in this group of patients appear to be under-utilised.
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Affiliation(s)
- Jeremy P Dwyer
- Department of Cardiology, Concord Repatriation Hospital, Concord Clinical School and Anzac Research Institute Vascular Biology Group, University of Sydney, NSW, Australia
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Rigatelli G. Patent foramen ovale: the evident paradox between the apparently simple treatment and the really complex pathophysiology. J Cardiovasc Med (Hagerstown) 2007; 8:300-4. [PMID: 17413311 DOI: 10.2459/01.jcm.0000263497.99157.77] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The simplicity and high safety profile of the new generation family of devices, and in particular of the last generation of occluder device, has given impetus to the diffusion of patent foramen ovale (PFO) transcatheter closure, which appears to be very simple and safe. Paradoxically, the pathophysiology of PFO is all but simple and the fact that many details of PFO-mediated syndromes are not yet fully understood is taken as proof of improper PFO closure by skeptics. However, on careful in-depth analysis of this apparently straightforward operation, many potential problems can be found at different stages; from a technical point of view, nickel toxicity, the possibility of thrombus formation, presence of residual shunt, malpositioning, and erosions are still active and real problems, whereas the pathophysiology of right-to-left shunt, role of coagulation abnormalities, significance of atrial septal aneurysm and other sources of shunt remain unresolved issues. Multidisciplinary task forces with PFO-related syndromes surveillance programs and highly-skilled interventional cardiologists are likely to increase the effectiveness and safety of PFO management.
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Affiliation(s)
- Gianluca Rigatelli
- Interventional Cardiology Unit, Division of Cardiology, Department of Emergency-Urgency Medicine, Rovigo General Hospital, Rovigo, Italy.
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Wilson RF, White CW. Coronary Angiography. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Rigatelli G, Braggion G, Chinaglia M, Cardaioli P, Roncon L, Giordan M, Cuppini S, Aggio S, Bortolazzi A, Zonzin P. Setting Up a Multidisciplinary Program for Management of Patent Foramen Ovale-Mediated Syndromes. J Interv Cardiol 2006; 19:264-8. [PMID: 16724970 DOI: 10.1111/j.1540-8183.2006.00141.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND These days no codified multidisciplinary protocol has been reported to manage all the different patent foramen ovale (PFO)-mediated syndromes. We sought to propose a multidisciplinary program of diagnosis, treatment, and follow-up of all PFO-mediated syndromes based on an in-hospital multidisciplinary task force and to review the activities during the first year. METHODS From September 2004, we organized in our hospital, a 600-bed tertiary hospital, a management program for PFO-mediated syndromes based on a task force composed of cardiologists, neurologists, and internists. Different levels of protocols were created in order to cover diagnosis, treatment, and follow-up of PFO-mediated syndromes. We reviewed the activity of our program in the first year up to September 2005. RESULTS Thirty-five patients (23 female, mean age 65 +/- 24 years) were evaluated for suspected PFO-mediated syndromes: 20 for cryptogenic stroke, 2 for peripheral and coronary embolisms, 3 for platypnea-orthodeoxia, 9 for emicrania with aura, and 1 with hypoxiemia during neurosurgical intervention in the posterior cranial fossa. Diagnosis of PFO was confirmed in 25 patients. According to the multidisciplinary protocols, 15 patients failed to meet the requirements for transcatheter closure and were left in medical therapy whereas 11 patients (7 patients with PFO, 2 with multiperforated ASD, and 2 with a secundum ASD) underwent transcatheter closure. After a mean follow-up of 10.8 +/- 4.9 months, no recurrent PFO syndromes were noted in patients treated with devices. CONCLUSION The first year of our multidisciplinary program allowed a reasonable and potentially successful approach for correctly identifying patients with PFO-mediated syndromes until randomized studies are completed.
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