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Apostolovic S, Aleksandric S, Beleslin B. Editorial: Spontaneous coronary artery dissection: current state of diagnosis and treatment. Front Cardiovasc Med 2024; 11:1455983. [PMID: 39070557 PMCID: PMC11273786 DOI: 10.3389/fcvm.2024.1455983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Affiliation(s)
- Svetlana Apostolovic
- Cardiology Clinic, University Clinical Center of Nis, Nis, Serbia
- Medical Faculty, University of Nis, Nis, Serbia
| | - Srdjan Aleksandric
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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2
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Steffek Z, Kurz DJ, Bernheim AM, Meyer MR. Severe multifocal coronary artery spasms after cessation of vasodilators in a patient with a spontaneous coronary artery dissection: a case report. Eur Heart J Case Rep 2024; 8:ytae282. [PMID: 38912118 PMCID: PMC11192059 DOI: 10.1093/ehjcr/ytae282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 06/25/2024]
Abstract
Background Vasospastic angina (VSA) and spontaneous coronary artery dissection (SCAD) are challenging causes of non-atherosclerotic acute coronary syndromes (ACS). Here, we report a unique ACS case with coexisting VSA and SCAD, highlighting specific strategies in diagnosis and management of these poorly studied conditions. Case summary A woman in her mid-60s with a history of suspected microvascular angina and no atherosclerosis in a previously performed coronary computed tomography angiography presented with worsening chest pain. Invasive coronary angiography revealed a focal SCAD with a resulting high-degree stenosis of the right coronary artery. Shortly after successful percutaneous coronary intervention with stent implantation and stopping her previous vasodilator therapy with nitroglycerine and molsidomine, the patient developed recurrent anterior non-ST-segment elevation myocardial infarction. Surprisingly, repeat coronary angiography revealed severe multifocal coronary artery spasms that were successfully treated with intracoronary nitroglycerine. Vasospastic angina was subsequently managed with diltiazem, molsidomine, and nitrates. Discussion Our report underscores the challenges in diagnosing and managing SCAD and VSA in ACS. The possible interplay between SCAD and VSA highlights the need for careful vasodilator therapy management, as seen in our patient, where therapy discontinuation led to severe multifocal VSA. This emphasizes the need for a comprehensive approach for optimal outcomes in complex ACS cases.
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Affiliation(s)
- Zdenek Steffek
- Division of Cardiology, Stadtspital Zürich Triemli, Birmensdorferstrasse 497, CH-8063 Zürich, Switzerland
- Division of Cardiology, Kantonsspital St. Gallen, Rorschacher Strasse 95, CH-9007 St. Gallen, Switzerland
| | - David J Kurz
- Division of Cardiology, Stadtspital Zürich Triemli, Birmensdorferstrasse 497, CH-8063 Zürich, Switzerland
| | - Alain M Bernheim
- Division of Cardiology, Stadtspital Zürich Triemli, Birmensdorferstrasse 497, CH-8063 Zürich, Switzerland
| | - Matthias R Meyer
- Division of Cardiology, Stadtspital Zürich Triemli, Birmensdorferstrasse 497, CH-8063 Zürich, Switzerland
- Division of Cardiology, Kantonsspital Graubünden, Loëstrasse 170, CH-7000 Chur, Switzerland
- Institute of Primary Care, University of Zürich, Pestalozzistrasse 24, CH-8091 Zürich, Switzerland
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3
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Cosma J, Russo A, Ferradini V, Gobbi C, Mallia V, Zuffi A, Joret C, Sacca S, Mango R. Spontaneous coronary artery dissection: review, case report and analysis of COVID-19-related cases. Minerva Cardiol Angiol 2024; 72:251-265. [PMID: 36847436 DOI: 10.23736/s2724-5683.22.06195-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) accounts for 1-4% of all acute coronary syndromes (ACS). Since the first description in 1931, our understanding of the disease has evolved; however, its pathophysiology and management are still a matter of debate. SCAD typically occurs in a middle-aged woman with no or few traditional cardiovascular risk factors. Two hypotheses have been proposed to explain the pathophysiology depending on the primary event: an intimal tear in the "inside-out" hypothesis and a spontaneous hemorrhage from the vasa vasorum in the "outside-in" hypothesis. Etiology appears to be multifactorial: different predisposing and precipitating factors have been identified. Coronary angiography is the gold standard for the diagnosis of SCAD. Current recommendations on the treatment of SCAD patients are based on expert opinions: a conservative strategy is preferred in hemodynamically stable SCAD patients, while urgent revascularization should be considered in hemodynamically unstable patients. Eleven cases of SCAD in COVID-19 patients have already been described: although the exact pathophysiological mechanism remains unclear, COVID-19-related SCAD is considered a combination of significant systemic inflammatory response and localized vascular inflammation. We present a literature review of SCAD, and we report an unpublished case of SCAD in a COVID-19 patient.
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Affiliation(s)
- Joseph Cosma
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France -
| | - Alessandro Russo
- Department of Cardiology, Ospedale Civile di Mirano, Mirano, Venice, Italy
| | - Valentina Ferradini
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Cecilia Gobbi
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France
| | - Vincenzo Mallia
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France
| | - Andrea Zuffi
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France
| | - Cédric Joret
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France
| | - Salvatore Sacca
- Department of Cardiology, Ospedale Civile di Mirano, Mirano, Venice, Italy
| | - Ruggiero Mango
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
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4
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Eltabbakh A, Khudair A, Khudair A, Fredericks S. Spontaneous coronary artery dissection and fibromuscular dysplasia: insights into recent developments. Front Cardiovasc Med 2024; 11:1409278. [PMID: 38883987 PMCID: PMC11176522 DOI: 10.3389/fcvm.2024.1409278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD), an uncommon cause of acute coronary syndrome, continues to be a poorly understood disease predominantly affecting females. It is characterized by an abrupt separation in the coronary arterial wall due to intramural bleeding. Fibromuscular dysplasia (FMD) is a non-atherosclerotic arteriopathy manifesting in medium and small-sized arteries. It is a concomitant disease found among SCAD patients. In some studies, FMD prevalence in SCAD patients ranges between 25%-86%, which can be explained through varying screening techniques or modalities. The potential association has been elucidated in some studies; notably, not only has a genetic link been recently delineated between SCAD and FMD, but there is data to suggest that FMD not only can predispose to SCAD but can also be a potential predictor of its recurrence. However, a clear-cut correlation between the two has still not been established due to conflicting reports in the literature. To further dive into its pathology, it is crucial to highlight the importance of systematic screening in SCAD in order to identify associated risk factors and to be used as a method of FMD detection in such patients. Together, the two pathologies pose unique challenges in understanding its pathophysiology, diagnosis and management, as there is no clear evidence of a definitive treatment plan for patients with SCAD and FMD. A potentially beneficial modality of management is physical exercise, which is currently understudied in the long-term approach to treatment for patients with concomitant SCAD and FMD. Limited research in this field brings disadvantages to the understanding of the association between these two diseases, in order to give rise to better management recommendations. This mini-review aims to highlight the recent developments in the association between SCAD and FMD, its potential genetic association and some insights in screening, diagnosis, and management.
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Affiliation(s)
- Ayah Eltabbakh
- Department of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Ahmed Khudair
- Department of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Aiman Khudair
- Department of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Salim Fredericks
- Department of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
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García-Guimarães M, Bastante T, Del Val D, Fernández-Rodríguez D, Guiberteau-Diaz T, Salamanca J, Rivero F, Alfonso F. Angiographic patterns in spontaneous coronary artery dissection: novel diagnostic insights. Expert Rev Cardiovasc Ther 2024; 22:167-175. [PMID: 38683109 DOI: 10.1080/14779072.2024.2349103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Spontaneous coronary artery dissection (SCAD) is a rare but well-recognized cause of acute coronary syndrome, especially important in women. Invasive coronary angiography (ICA) is the fundamental diagnostic technique for the confirmation of SCAD. Knowing the angiographic patterns suggestive of SCAD is essential for the correct identification of patients with this entity. AREAS COVERED In this narrative review, the main angiographic characteristics of SCAD lesions as detected by ICA are presented and discussed. EXPERT OPINION In addition to the specific angiographic classification of SCAD, several authors have described complementary angiographic patterns suggestive of SCAD. Knowledge and correct identification of these angiographic patterns is essential for the correct diagnosis of patients with clinical suspicion of SCAD.
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Affiliation(s)
- Marcos García-Guimarães
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
- Cardiology Department, Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Teresa Bastante
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - David Del Val
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - Diego Fernández-Rodríguez
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
- Cardiology Department, Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | | | - Jorge Salamanca
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - Fernando Rivero
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - Fernando Alfonso
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
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6
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D’Amato A, Mariani MV, Prosperi S, Colombo L, De Prisco A, Lavalle C, Mancone M, Vizza CD, Severino P. Spontaneous Coronary Artery Dissection in Clinical Practice: Pathophysiology and Therapeutic Approaches. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:217. [PMID: 38399505 PMCID: PMC10889982 DOI: 10.3390/medicina60020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Spontaneous coronary artery dissection (SCAD) is a cause of myocardial infarction without obstructive coronary artery disease (MINOCA). It is determined by a coronary artery wall layers separation, which occurs regardless of traumatic or iatrogenic injuries. Even if it is often a missed diagnosis, its incidence is growing along with the improvement of intracoronary imaging techniques that allow for better detection. The main angiographical classification distinguishes three different forms, with slightly different prognoses at long-term follow up. SCAD is a recurrent condition, severely hampering the life quality of affected patients. The predominantly young age of patients with SCAD and the high prevalence of females among them have made the topic increasingly important, especially regarding therapeutic strategies. According to the data, the most recommended treatment is conservative, based on the use of antiplatelet agents and supportive anti-ischemic therapy. However, there are conflicting opinions concerning the need for dual antiplatelet therapy and its duration. In the case of invasive treatment, the choice between percutaneous coronary intervention and coronary artery bypass graft depends on the patient's clinical stability and the interested vessel. The purpose of the current review is to revise the pathophysiological mechanisms underlying SCAD and the current knowledge of its treatment.
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Affiliation(s)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 00161 Rome, Italy; (A.D.); (S.P.); (L.C.); (A.D.P.); (C.L.); (M.M.); (C.D.V.); (P.S.)
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7
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Würdinger M, Schweiger V, Gilhofer T, Cammann VL, Badorff A, Koleva I, Di Vece D, Niederseer D, Candreva A, Michel J, Gotschy A, Stehli J, Stähli BE, Ghadri JR, Templin C. Twenty-five-year trends in incidence, angiographic appearance, and management of spontaneous coronary artery dissection. Int J Cardiol 2024; 395:131429. [PMID: 37827283 DOI: 10.1016/j.ijcard.2023.131429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) has been described as an infrequent cause of acute coronary syndrome (ACS). Knowledge about the disease is still limited and SCAD might still be underdiagnosed. OBJECTIVES Trends in incidence, presentation, angiographic appearance, management, and outcomes of SCAD over 25 years were analyzed. METHODS Patients with SCAD between 1997 and 2021 at the University Hospital Zurich, Switzerland, were included. Incidences were assessed as total numbers and proportions of ACS cases. Clinical data were collected from medical records and angiographic findings were reviewed. Major adverse cardiac events (MACE) were defined as the composite of all-cause death, cardiac arrest, SCAD recurrence or progression, other myocardial infarction, and stroke. RESULTS One hundred fifty-six SCAD cases were included in this study. The incidence increased significantly in total (p < 0.001) and relative to ACS cases (p < 0.001). This was based on an increase of shorter lesions (p = 0.004), SCAD type 2 (p < 0.001), and lesions in side branches (p = 0.014), whereas lesions in the left main coronary artery and proximal segments were decreasing (p-values 0.029 and < 0.001, respectively). There was an increase in conservative therapy (p < 0.001). The rate of MACE (24%) was stable, however, there was a reduced proportion of patients with a need for intensive care treatment (p = 0.017). CONCLUSIONS SCAD represents an important entity of ACS that still might be underappreciated. The increasing incidence of SCAD is likely based on better awareness and familiarity with the disease. A lower need for intensive care treatment suggests positive effects of the increasing implementation of conservative management.
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Affiliation(s)
- Michael Würdinger
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Victor Schweiger
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Thomas Gilhofer
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Annika Badorff
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Iva Koleva
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Davide Di Vece
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - David Niederseer
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Jonathan Michel
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Alexander Gotschy
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Julia Stehli
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
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8
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Djokovic A, Krljanac G, Matic P, Zivic R, Djulejic V, Marjanovic Haljilji M, Popovic D, Filipovic B, Apostolovic S. Pathophysiology of spontaneous coronary artery dissection: hematoma, not thrombus. Front Cardiovasc Med 2023; 10:1260478. [PMID: 37928766 PMCID: PMC10623160 DOI: 10.3389/fcvm.2023.1260478] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) accounts for 1.7%-4% of all acute coronary syndrome presentations, particularly among young women with an emerging awareness of its importance. The demarcation of acute SCAD from coronary atherothrombosis and the proper therapeutic approach still represents a major clinical challenge. Certain arteriopathies and triggers are related to SCAD, with high variability in their prevalence, and often, the cause remains unknown. The objective of this review is to provide contemporary knowledge of the pathophysiology of SCAD and possible therapeutic solutions.
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Affiliation(s)
- Aleksandra Djokovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Predrag Matic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular Surgery, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Rastko Zivic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Surgery, Clinical Hospital Center Dr Dragisa Misovic “Dedinje”, BelgradeSerbia
| | - Vuk Djulejic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia
| | | | - Dusan Popovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Gastroenterology, Clinical Hospital Center Dr Dragisa Misovic “Dedinje”, BelgradeSerbia
| | - Branka Filipovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Gastroenterology, Clinical Hospital Center Dr Dragisa Misovic “Dedinje”, BelgradeSerbia
| | - Svetlana Apostolovic
- Coronary Care Unit, Cardiology Clinic, University Clinical Center of Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
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Mehmedbegović Z, Ivanov I, Čanković M, Perišić Z, Kostić T, Maričić B, Krljanac G, Beleslin B, Apostolović S. Invasive imaging modalities in a spontaneous coronary artery dissection: when "believing is seeing". Front Cardiovasc Med 2023; 10:1270259. [PMID: 37920180 PMCID: PMC10618678 DOI: 10.3389/fcvm.2023.1270259] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome (ACS) with recent advancements in cardiac imaging facilitating its identification. However, SCAD is still often misdiagnosed due to the absence of angiographic hallmarks in a significant number of cases, highlighting the importance of meticulous interpretation of angiographic findings and, when necessary, additional usage of intravascular imaging to verify changes in arterial wall integrity and identify specific pathoanatomical features associated with SCAD. Accurate diagnosis of SCAD is crucial, as the optimal management strategies for patients with SCAD differ from those with atherosclerotic coronary disease. Current treatment strategies favor a conservative approach, wherein intervention is reserved for cases with persistent ischemia, patients with high-risk coronary anatomy, or patients with hemodynamic instability. In this paper, we provide a preview of invasive imaging modalities and classical angiographic and intravascular imaging hallmarks that may facilitate proper SCAD diagnosis.
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Affiliation(s)
- Zlatko Mehmedbegović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Ivanov
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Cardiology Clinic, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Milenko Čanković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Cardiology Clinic, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Zoran Perišić
- Faculty of Medicine, University of Niš, Niš, Serbia
- Division of Interventional Cardiology, University Clinical Center Niš, Niš, Serbia
| | - Tomislav Kostić
- Faculty of Medicine, University of Niš, Niš, Serbia
- Division of Interventional Cardiology, University Clinical Center Niš, Niš, Serbia
| | - Bojan Maričić
- Division of Interventional Cardiology, University Clinical Center Niš, Niš, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Branko Beleslin
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Svetlana Apostolović
- Faculty of Medicine, University of Niš, Niš, Serbia
- Division of Interventional Cardiology, University Clinical Center Niš, Niš, Serbia
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Gurgoglione FL, Rizzello D, Giacalone R, Ferretti M, Vezzani A, Pfleiderer B, Pelà G, De Panfilis C, Cattabiani MA, Benatti G, Tadonio I, Grassi F, Magnani G, Noni M, Cancellara M, Nicolini F, Ardissino D, Vignali L, Niccoli G, Solinas E. Precipitating factors in patients with spontaneous coronary artery dissection: Clinical, laboratoristic and prognostic implications. Int J Cardiol 2023; 385:1-7. [PMID: 37211051 DOI: 10.1016/j.ijcard.2023.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) often presents with acute coronary syndrome and underlying pathophysiology involves the interplay between predisposing factors and precipitating stressors, such as emotional and physical triggers. In our study we sought to compare clinical, angiographic and prognostic features in a cohort of patients with SCAD according to the presence and type of precipitating stressors. METHODS Consecutive patients with angiographic evidence of SCAD were divided into three groups: patients with emotional stressors, patients with physical stressors and those without any stressor. Clinical, laboratoristic and angiographic features were collected for each patient. The incidence of major adverse cardiovascular events, recurrent SCAD and recurrent angina was assessed at follow-up. RESULTS Among the total population (64 subjects), 41 [64.0%] patients presented with precipitating stressors, including emotional triggers (31 [48.4%] subjects) and physical efforts (10 [15.6%] subjects). As compared with the other groups, patients with emotional triggers were more frequently female (p = 0.009), had a lower prevalence of hypertension (p = 0.039] and dyslipidemia (p = 0.039), were more likely to suffer from chronic stress (p = 0.022) and presented with higher levels of C-reactive protein (p = 0.037) and circulating eosinophils cells (p = 0.012). At a median follow-up of 21 [7; 44] months, patients with emotional stressors experienced higher prevalence of recurrent angina (p = 0.025), as compared to the other groups. CONCLUSIONS Our study shows that emotional stressors leading to SCAD may identify a SCAD subtype with specific features and a trend towards a worse clinical outcome.
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Affiliation(s)
| | - Davide Rizzello
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy
| | | | - Marco Ferretti
- Division of Cardiology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Antonella Vezzani
- Cardiac Surgery Intensive Care Unit, Parma University Hospital, Parma, Italy
| | | | - Giovanna Pelà
- Department of Medicine and Surgery, University of Parma, Italy
| | | | | | - Giorgio Benatti
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Iacopo Tadonio
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Giulia Magnani
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Manjola Noni
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Francesco Nicolini
- Division of Cardio surgery, University of Parma, Parma University Hospital, Parma, Italy
| | - Diego Ardissino
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy
| | - Luigi Vignali
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Giampaolo Niccoli
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy.
| | - Emilia Solinas
- Division of Cardiology, Parma University Hospital, Parma, Italy
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11
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Whittington B, Tzolos E, Williams MC, Dweck MR, Newby DE. Imaging of intracoronary thrombus. Heart 2023; 109:740-747. [PMID: 36549679 DOI: 10.1136/heartjnl-2022-321361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
The identification of intracoronary thrombus and atherothrombosis is central to the diagnosis of acute myocardial infarction, with the differentiation between type 1 and type 2 myocardial infarction being crucial for immediate patient management. Invasive coronary angiography has remained the principal imaging modality used in the investigation of patients with myocardial infarction. More recently developed invasive intravascular imaging approaches, such as angioscopy, intravascular ultrasound and optical coherence tomography, can be used as adjunctive imaging modalities to provide more direct visualisation of coronary atheroma and the causes of myocardial infarction as well as to improve the sensitivity of thrombus detection. However, these invasive approaches have practical and logistic constraints that limit their widespread and routine application. Non-invasive angiographic techniques, such as CT and MRI, have become more widely available and have improved the non-invasive visualisation of coronary artery disease. Although they also have a limited ability to reliably identify intracoronary thrombus, this can be overcome by combining their anatomical and structural characterisation of coronary anatomy with positron emission tomography. Specific radiotracers which bind with high specificity and sensitivity to components of thrombus, such as activated platelets, fibrin and factor XIIIa, hold promise for the non-invasive detection of intracoronary thrombus. The development of these novel non-invasive approaches has the potential to inform clinical decision making and patient management as well as to provide a non-invasive technique to assess the efficacy of novel antithrombotic therapies or interventional strategies. However, these have yet to be realised in routine clinical practice.
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Affiliation(s)
- Beth Whittington
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
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Clinical and angiographic features of SCAD type 4. Int J Cardiol 2023; 377:22-25. [PMID: 36716971 DOI: 10.1016/j.ijcard.2023.01.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The angiographic type 4 in SCAD is described as a total occlusion of the coronary artery and its management may differ according to its clinical presentation. We previously have observed that these patients present a low incidence of adverse events. Our objective was to describe clinical and angiographic characteristics of this condition, according to its initial management in the DISCO registry. METHODS We conducted an observational study of consecutive SCAD patients from 26 centres of Italy and Spain (DISCO registry). Angiotype 4 SCAD cases were selected and classified according to the initial treatment chosen: conservative management vs. percutaneous coronary intervention (PCI). Clinical and angiographic characteristics were compared. RESULTS We recruited 81 (mean age 52.6 ± 11 years) patients with SCAD angiotype 4 out of 302 patients of the DISCO registry. Thirty-eight (46.9%) patients received conservative management and 43 (53.1%) received PCI. Nearly all patients undergoing PCI had ST-segment elevation (93% vs 47.4%, p < 0.0001), the left anterior descending artery (LAD) was more commonly involved (67.4% vs. 42.1%, p = 0.006), and they had more frequent proximal segment involvement (25.6% vs 2.7%, p = 0.004) and longer lesions (46.5 ± 23.2 mm vs 26.4 ± 18.8 mm, p = 0.017). On the other hand, non-ST-segment elevation myocardial infarction (52.6% vs 2.3%, p = 0.001) and isolated involvement of secondary branches (55.3 vs 4.7, p < 0.0001) were more common in the conservative management group. CONCLUSIONS Patients with SCAD angiotype 4 who underwent PCI had a higher frequency of STEMI and involvement of proximal and longer coronary segments, particularly affecting the left anterior descending artery. NSTEMI and isolated involvement of secondary branches were more frequently found in those managed conservatively.
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Lionakis N, Briasoulis A, Zouganeli V, Dimopoulos S, Kalpakos D, Kourek C. Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies. World J Cardiol 2022; 14:522-536. [PMID: 36339886 PMCID: PMC9627356 DOI: 10.4330/wjc.v14.i10.522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/14/2022] [Accepted: 10/06/2022] [Indexed: 02/05/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors. SCAD is frequently linked with predisposing factors, such as postpartum, fibromuscular dysplasia or other vasculopathies, connective tissue disease and hormonal therapy, and it is often triggered by intense physical or emotional stress, sympathomimetic drugs, childbirth and activities increasing shear stress of the coronary artery walls. Patients with SCAD usually present at the emergency department with chest discomfort, chest pain, and rapid heartbeat or fluttery. During the last decades, the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis. However, modern imaging techniques such as optical coherence tomography, intravascular ultrasound, coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease. Treatment of SCAD remains controversial, especially during the last years, where invasive techniques are being used more often and in more emergent cardiac syndromes. Although conservative treatment combining aspirin and beta-blocker remains the recommended strategy in most cases, revascularization could also be suggested as a method of treatment in specific indications, but with a higher risk of complications. The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients. Follow-up should be performed on a regular basis.
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Affiliation(s)
- Nikolaos Lionakis
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, Alexandra Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa Hospitals and Clinics, IA 52242, United States
| | - Virginia Zouganeli
- Second Cardiology Department, Attikon University Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Dionisios Kalpakos
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Christos Kourek
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
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14
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Khiatah B, Jazayeri S, Yamamoto N, Burt T, Frugoli A, Brooks DL. Cardiovascular disease in women: A review of spontaneous coronary artery dissection. Medicine (Baltimore) 2022; 101:e30433. [PMID: 36197250 PMCID: PMC9509023 DOI: 10.1097/md.0000000000030433] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/28/2022] [Indexed: 11/27/2022] Open
Abstract
Research has demonstrated the disproportionate quality of care for women with cardiovascular disease. These findings have prompted a renewed focus on cardiovascular disease awareness and disease prevention in women. Spontaneous coronary artery dissection (SCAD) is a significant cause of myocardial infarction (MI) and sudden death that primarily affects women. ongoing research has led to improved diagnostic capabilities and changes in approaches to initial and long-term management most importantly this research has provided evidence that SCAD is more common than previously thought and must be evaluated and treated differently from atherosclerotic MI. The difference between SCAD and atherosclerotic MI is highlighted in high rates of recurrent disease, gender distribution, association with exogenous hormones, pregnancy, migraine, physical and emotional stress triggers, concurrent systemic arteriopathies, and connective tissue disease. In this review, we provide updated insights and a summary of the epidemiology, risk factors, clinical presentation, diagnosis, treatment options, prognosis, and recurrence prevention of SCAD. We aim to provide a review of SCAD as a focus on cardiovascular disease awareness and disease prevention in women.
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Affiliation(s)
- Bashar Khiatah
- Community Memorial Hospital, Internal Medicine Department, Ventura, CA, USA
| | - Sam Jazayeri
- Community Memorial Hospital, Internal Medicine Department, Ventura, CA, USA
| | - Naofumi Yamamoto
- College of Osteopathic Medicine of the Pacific, Western University, Pomona, CA, USA
| | - Tristen Burt
- College of Osteopathic Medicine of the Pacific, Western University, Pomona, CA, USA
| | - Amanda Frugoli
- Community Memorial Hospital, Internal Medicine Department, Ventura, CA, USA
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Ahmed T, Honaker O, Misumida N, Messerli AW. Spontaneous Coronary Artery Dissection (SCAD) complicated with post-infarction ventricular septal rupture and a comparative review on mechanical complications related with SCAD. Curr Probl Cardiol 2022:101229. [DOI: 10.1016/j.cpcardiol.2022.101229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022]
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Barbieri L, D’Errico A, Avallone C, Gentile D, Provenzale G, Guagliumi G, Tumminello G, Carugo S. Optical Coherence Tomography and Coronary Dissection: Precious Tool or Useless Surplus? Front Cardiovasc Med 2022; 9:822998. [PMID: 35433885 PMCID: PMC9010532 DOI: 10.3389/fcvm.2022.822998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/22/2022] [Indexed: 01/28/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare clinical condition, but frequently manifested as acute myocardial infarction. In this particular setting, in recent years, optical coherence tomography (OCT) has been established as a possible diagnostic method due to the high spatial resolution (10–20 μm), which can visualize the different layers of coronary vessels. OCT can better analyze the “binary” or double lumen morphology, typical of this entity. Furthermore, it can identify the entrance breach and the circumferential and longitudinal extension of the lesion. However, we have to emphasize that this technique is not free from complications. OCT could further aggravate a dissection or exacerbate a new intimal tear. Therefore, the use of OCT in the evaluation of SCAD should be defined by balancing the diagnostic benefits versus procedural risks. Moreover, we underline that as SCAD is a rare condition and OCT is a recently introduced technique in clinical practice, limited data is available in literature.
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Affiliation(s)
- Lucia Barbieri
- Cardiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- *Correspondence: Lucia Barbieri,
| | - Andrea D’Errico
- Cardiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Carlo Avallone
- Cardiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Domitilla Gentile
- Cardiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Giovanni Provenzale
- Cardiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Giulio Guagliumi
- Department of Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Gabriele Tumminello
- Cardiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Stefano Carugo
- Cardiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
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Martinez S, Giménez-Milà M, Cepas P, Anduaga I, Masotti M, Matute P, Castellà M, Sabaté M. Spontaneous Coronary Artery Dissection: Rediscovering an Old Cause of Myocardial Infarction. J Cardiothorac Vasc Anesth 2022; 36:3303-3311. [PMID: 35618587 DOI: 10.1053/j.jvca.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/28/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022]
Abstract
Spontaneous coronary artery dissection is an uncommon, but not insignificant cause of acute coronary syndrome that overwhelmingly affects middle-aged women. The pathophysiology of coronary dissection appears to be an outside-in mechanism, where the initiating event is not an intimal tear but rather the formation of an intramural hematoma, which compromises blood flow by reducing the arterial lumen. Considering this mechanism, it is clear to see how intracoronary imaging techniques, such as optical coherence tomography and intravascular ultrasound, are most accurate in the diagnosis. However, they carry a high rate of complications and are therefore generally avoided when the clinical scenario and angiographic appearance both support the diagnosis of spontaneous coronary artery dissection. The natural history of the disease is toward healing of the vessel wall and restoration of blood flow. Therefore, conservative medical management is the preferred approach unless there are high-risk factors such as hemodynamic instability, signs of ischemia and severe proximal or multivessel lesions, in which percutaneous or surgical revascularization should be considered. Perioperative evaluation of these patients must take into account several aspects of this disease. Most of these patients will be receiving single or dual antiplatelet therapy, so one must consider the timing of the event and the surgical hemorrhagic risk when deciding to stop these therapies. Extracoronary vascular disease also must be assessed because it can have an effect on patient monitoring and risk of postoperative complications.
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Affiliation(s)
- Samira Martinez
- Department of Anesthesia and Intensive Care, Hospital CLINIC de Barcelona, Barcelona, Spain
| | - Marc Giménez-Milà
- Department of Anesthesia and Intensive Care, Hospital CLINIC de Barcelona, Barcelona, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.
| | - Pedro Cepas
- Institut d'investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain; Department of Cardiology, Hospital CLINIC de Barcelona, Barcelona, Spain
| | - Iñigo Anduaga
- Department of Cardiology, Hospital CLINIC de Barcelona, Barcelona, Spain
| | - Monica Masotti
- Institut d'investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain; Department of Cardiology, Hospital CLINIC de Barcelona, Barcelona, Spain
| | - Purificación Matute
- Department of Anesthesia and Intensive Care, Hospital CLINIC de Barcelona, Barcelona, Spain
| | - Manel Castellà
- Department of Cardiovascular Surgery and Transplantation, Hospital CLINIC de Barcelona, Barcelona, Spain
| | - Manel Sabaté
- Institut d'investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain; Department of Cardiology, Hospital CLINIC de Barcelona, Barcelona, Spain
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Liu SF, Zhao YN, Jia CW, Ma TY, Cai SD, Gao F. Spontaneous dissection of proximal left main coronary artery in a healthy adolescent presenting with syncope: A case report. World J Clin Cases 2022; 10:2341-2350. [PMID: 35321168 PMCID: PMC8895162 DOI: 10.12998/wjcc.v10.i7.2341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/29/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a frequent cause of acute coronary syndrome in young to middle-aged women with few or no traditional cardiovascular risk factors. Chest pain is the most frequently described presenting symptom, but syncope is extremely rare. Herein, we report on a 16-year-old girl who presented with an episode of syncope occurring during a race. Despite significantly elevated troponin level, the diagnosis of the left main coronary artery SCAD with cardiogenic shock was delayed.
CASE SUMMARY A 16-year-old girl presented with an episode of syncope. Myocardial injury markers were positive. Echocardiography showed a mildly reduced left ventricular ejection fraction (50%). Although initially stable, she later experienced recurrent chest pain accompanying precordial ST segment elevation with dynamic changes and developed cardiogenic shock, necessitating emergent revascularization. Coronary angiography demonstrated almost total occlusion at the ostium and proximal segment of the left main trunk coronary artery (LMT). Intravascular ultrasound confirmed a false lumen with prominent dissection in the LMT. Percutaneous coronary intervention assisted by intra-aortic balloon pump was conducted in the LMT. A 3.5 mm × 24 mm everolimus-eluting stent was deployed to the focal lesions of the LMT. A postprocedural electrocardiogram showed alleviation of the precordial ST-segment elevation. The diagnosis of SCAD was confirmed. Transthoracic echocardiography showed an improved left ventricular ejection fraction (57%). The patient was asymptomatic during the 24-mo. follow-up period.
CONCLUSION SCAD should always be considered in the differential diagnosis of acute coronary syndrome presentations in low-risk patients, regardless of age.
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Affiliation(s)
- Sui-Feng Liu
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Ya-Nan Zhao
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Chun-Wen Jia
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Tian-Yi Ma
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Shi-Da Cai
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Feng Gao
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
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Almasi A, Mansouri P, Jameie M, Yadangi S, Parapary SH, Mohsenizadeh SA, Jamshidi P, Jenab Y. Clinical Features and Prognoses of Middle-Aged Women With ST-Elevation Myocardial Infarction With a Focus on Spontaneous Coronary Artery Dissection. Crit Pathw Cardiol 2022; 21:18-23. [PMID: 34919066 DOI: 10.1097/hpc.0000000000000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) has become an increasingly recognized cause of acute coronary syndrome, particularly in young women, over the last decade. The goal of this study was to determine the prognoses and characteristics of adult women with SCAD who presented with ST-elevation myocardial infarction (STEMI). METHODS This retrospective cohort study enrolled all adult women under the age of 60 who had undergone coronary artery angiography in the setting of STEMI. The patients were divided into 3 groups based on their angiographic characteristics: STEMI-SCAD (STEMI due to SCAD), STEMI-ATH (STEMI caused by an atherosclerotic lesion), and STEMI-others (STEMI due to other etiologies including Takotsubo cardiomyopathy and myopericarditis, as well as STEMI despite a normal epicardial coronary angiography). RESULTS Fifteen women out of 311 female patients aged below 60 years with STEMI were diagnosed with SCAD (4.8%). There were no significant differences in body mass index, hypertension, dyslipidemia, smoking status, opium addiction status, family history, previous percutaneous coronary intervention, coronary artery bypass grafting, and cerebrovascular accidents between the STEMI-SCAD and STEMI-ATH groups. Nevertheless, the STEMI-SCAD and STEMI-others groups were more likely to be younger, less likely to be diabetic, and less likely to have 3 cardiovascular risk factors or more than was the STEMI-ATH group. The left anterior descending artery was the most common culprit lesion in the STEMI-SCAD group (80%) and the other 2 groups. Out of the 311 patients, 7 patients died during the index hospitalization: 1 patient in the STEMI-SCAD group, 6 patients in the STEMI-ATH group, and 0 patients in the STEMI-others group. None of the patients in the STEMI-others group experienced any major adverse cardiac events during the follow-up. In the other 2 groups, the most experienced outcomes were myocardial infarction and in-hospital cardiac death, followed by target lesion revascularization and target vessel revascularization. CONCLUSIONS STEMI-SCAD is one of the known causes of STEMI in young women. Still, despite the complexity of revascularization in our patients with STEMI-SCAD, they had more favorable prognoses in both conservative and revascularization management modalities than our patients with STEMI-ATH.
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Affiliation(s)
- Aliasghar Almasi
- From the Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pejman Mansouri
- From the Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mana Jameie
- From the Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Yadangi
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Haghighi Parapary
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Peiman Jamshidi
- Department of Cardiology, Canton Hospital Lucerne, Lucerne, Switzerland
| | - Yaser Jenab
- From the Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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20
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Akhigbe EJ, Ezeh E, Mansoor K, Mader J, Okhumale PI, Lester M. The Self Sabotaging Vessel: A Case Report and Literature Review of Spontaneous Coronary Artery Dissection. Cureus 2021; 13:e20835. [PMID: 35111481 PMCID: PMC8794366 DOI: 10.7759/cureus.20835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/15/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a very rare cause of acute coronary syndrome. Despite the recent advances in the management of cardiovascular diseases, the diagnoses and management of SCAD remain a dilemma. It has been described to majorly affect females of childbearing age, immediately post-partum or on oral contraceptives. Recent cases have also identified underlying connective tissue disease as a risk factor. Since its discovery, only a limited number of cases affecting males have been reported in the literature. This makes our case unique. In this, we present a 31-year-old male without any traditional risk factors who presented with atypical chest pain. Electrocardiogram showed ST-segment changes with echocardiogram revealing apical left ventricular akinesis. A diagnostic left heart catheterization showed multiple lumens in the distal left anterior descending artery (LAD). The patient was managed conservatively and discharged home on guideline-directed medical therapy.
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21
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Amrani-Midoun A, Adlam D, Bouatia-Naji N. Recent Advances on the Genetics of Spontaneous Coronary Artery Dissection. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2021; 14:e003393. [PMID: 34706548 DOI: 10.1161/circgen.121.003393] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) has been acknowledged as a significant cause of acute myocardial infarction, predominantly in young to middle-aged women. SCAD often occurs in patients with fewer cardiovascular risk factors than atherosclerotic acute myocardial infarction. Unfortunately, SCAD remains underdiagnosed due to a lack of awareness among health care providers leading to misdiagnosis. The underlying pathophysiological mechanisms of SCAD are not well understood. SCAD occurring in members of the same family has been described, suggesting a potentially identifiable genetically triggered cause in at least some cases. However, thus far, the search for highly penetrant mutations in candidate pathways has had a low yield, often pointing to genes involved in other clinically undiagnosed hereditary syndromes manifesting as SCAD. Recent exploratory efforts using exome sequencing and genome-wide association studies have provided several interesting leads toward understanding the pathogenesis of SCAD. Here, we review recent publications where rare and common genetic factors were reported to associate with a predisposition to SCAD and indicate suggestions for the future strategies and approaches needed to fully address the genetic basis of this intriguing and atypical cause of acute myocardial infarction.
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Affiliation(s)
- Asma Amrani-Midoun
- Biotechnology Department, Faculty of Sciences of Nature and Life, University of Oran 1 Ahmed Ben Bella, Algeria (A.A.-M.)
| | - David Adlam
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (D.A.)
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22
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Adlam D, Tweet MS, Gulati R, Kotecha D, Rao P, Moss AJ, Hayes SN. Spontaneous Coronary Artery Dissection: Pitfalls of Angiographic Diagnosis and an Approach to Ambiguous Cases. JACC Cardiovasc Interv 2021; 14:1743-1756. [PMID: 34412792 PMCID: PMC8383825 DOI: 10.1016/j.jcin.2021.06.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/07/2021] [Accepted: 06/08/2021] [Indexed: 01/28/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is a pathophysiologically distinct cause of acute coronary syndromes (ACS). It is increasingly recognized that optimal management is different from that for atherosclerotic ACS and that a SCAD diagnosis has specific long-term prognostic and therapeutic implications. Accurate diagnosis is therefore essential to ensure the best treatment of patients. At present this relies on the recognition of typical features of SCAD identified on invasive coronary angiography. Although most SCAD can be readily distinguished angiographically from alternative causes of ACS, false positive and false negative diagnoses remain common. In particular, sometimes non-SCAD presentations, including atherothrombosis, takotsubo cardiomyopathy, coronary embolism, coronary vasospasm, contrast streaming, and myocardial infarction with nonobstructive coronary arteries, can mimic angiographic features usually associated with SCAD. The authors present the combined experience from European and US SCAD referral centers reviewing the classical angiographic appearances of SCAD, presenting potential diagnostic pitfalls and exemplars of SCAD mimickers. The authors further review the benefits and limitations of intracoronary imaging in the context of SCAD. Finally, the authors discuss the investigation of ambiguous cases and an approach to minimize misdiagnosis in difficult cases.
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Affiliation(s)
- David Adlam
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom.
| | - Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Deevia Kotecha
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Praveen Rao
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Alistair J Moss
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Cerrato E, Giacobbe F, Quadri G, Macaya F, Bianco M, Mori R, Biolè CA, Boi A, Bettari L, Rolfo C, Ferrari F, Annibali G, Scappaticci M, Pavani M, Barbero U, Buccheri D, Cavallino C, Lombardi P, Bernelli C, D'Ascenzo F, Infantino V, Gambino A, Cinconze S, Rognoni A, Montagna L, Porto I, Musumeci G, Escaned J, Varbella F. Antiplatelet therapy in patients with conservatively managed spontaneous coronary artery dissection from the multicentre DISCO registry. Eur Heart J 2021; 42:3161-3171. [PMID: 34338759 DOI: 10.1093/eurheartj/ehab372] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/23/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS The role of antiplatelet therapy in patients with spontaneous coronary artery dissection (SCAD) undergoing initial conservative management is still a matter of debate, with theoretical arguments in favour and against its use. The aims of this article are to assess the use of antiplatelet drugs in medically treated SCAD patients and to investigate the relationship between single (SAPT) and dual (DAPT) antiplatelet regimens and 1-year patient outcomes. METHODS AND RESULTS We investigated the 1-year outcome of patients with SCAD managed with initial conservative treatment included in the DIssezioni Spontanee COronariche (DISCO) multicentre international registry. Patients were divided into two groups according to SAPT or DAPT prescription. Primary endpoint was 12-month incidence of major adverse cardiovascular events (MACE) defined as the composite of all-cause death, non-fatal myocardial infarction (MI), and any unplanned percutaneous coronary intervention (PCI). Out of 314 patients included in the DISCO registry, we investigated 199 patients in whom SCAD was managed conservatively. Most patients were female (89%), presented with acute coronary syndrome (92%) and mean age was 52.3 ± 9.3 years. Sixty-seven (33.7%) were given SAPT whereas 132 (66.3%) with DAPT. Aspirin plus either clopidogrel or ticagrelor were prescribed in 62.9% and 36.4% of DAPT patients, respectively. Overall, a 14.6% MACE rate was observed at 12 months of follow-up. Patients treated with DAPT had a significantly higher MACE rate than those with SAPT [18.9% vs. 6.0% hazard ratios (HR) 2.62; 95% confidence intervals (CI) 1.22-5.61; P = 0.013], driven by an early excess of non-fatal MI or unplanned PCI. At multiple regression analysis, type 2a SCAD (OR: 3.69; 95% CI 1.41-9.61; P = 0.007) and DAPT regimen (OR: 4.54; 95% CI 1.31-14.28; P = 0.016) resulted independently associated with a higher risk of 12-month MACE. CONCLUSIONS In this European registry, most patients with SCAD undergoing initial conservative management received DAPT. Yet, at 1-year follow-up, DAPT, as compared with SAPT, was independently associated with a higher rate of adverse cardiovascular events (ClinicalTrial.gov id: NCT04415762).
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Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Federico Giacobbe
- Cardiology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giorgio Quadri
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Fernando Macaya
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Ricardo Mori
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Carlo Alberto Biolè
- Interventional cardiology unit, Cardinal Massaia Civil Hospital, Asti, Italy
| | | | - Luca Bettari
- Interventional cardiology unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Cristina Rolfo
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Fabio Ferrari
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Gianmarco Annibali
- Cardiology Department, A.O. Ordine Mauriziano, Ospedale Umberto I, Turin, Italy
| | | | - Marco Pavani
- Interventional cardiology unit, Ospedale Maggiore Ss. Annunziata, Savigliano, CN, Italy
| | - Umberto Barbero
- Interventional cardiology unit, Ospedale Maggiore Ss. Annunziata, Savigliano, CN, Italy
| | - Dario Buccheri
- Interventional Cardiology Unit, S. Antonio Abate Hospital, Trapani, Italy
| | | | - Primiano Lombardi
- Interventional cardiology unit, Cardinal Massaia Civil Hospital, Asti, Italy
| | - Chiara Bernelli
- Interventional cardiology unit, Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - Fabrizio D'Ascenzo
- Cardiology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Alfonso Gambino
- Interventional cardiology unit, Santa Croce Hospital, Moncalieri, TO, Italy
| | - Sebastian Cinconze
- Cardiology Department, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Andrea Rognoni
- Cardiology Department, Ospedale Maggiore della Carità, Novara, Italy
| | - Laura Montagna
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Giuseppe Musumeci
- Cardiology Department, A.O. Ordine Mauriziano, Ospedale Umberto I, Turin, Italy
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Ferdinando Varbella
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
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24
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Al-Hussaini A, Abdelaty AMSEK, Gulsin GS, Arnold JR, Garcia-Guimaraes M, Premawardhana D, Budgeon C, Wood A, Natarajan N, Mangion K, Rakhit R, Hoole SP, Johnson TW, Berry C, Hudson I, Gershlick AH, Ladwiniec A, Kovac J, Squire I, Samani NJ, Plein S, McCann GP, Adlam D. Chronic infarct size after spontaneous coronary artery dissection: implications for pathophysiology and clinical management. Eur Heart J 2021; 41:2197-2205. [PMID: 31898721 PMCID: PMC7299635 DOI: 10.1093/eurheartj/ehz895] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/29/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS To report the extent and distribution of myocardial injury and its impact on left ventricular systolic function with cardiac magnetic resonance imaging (CMR) following spontaneous coronary artery dissection (SCAD) and to investigate predictors of myocardial injury. METHODS AND RESULTS One hundred and fifty-eight angiographically confirmed SCAD-survivors (98% female) were phenotyped by CMR and compared in a case-control study with 59 (97% female) healthy controls (44.5 ± 8.4 vs. 45.0 ± 9.1 years). Spontaneous coronary artery dissection presentation was with non-ST-elevation myocardial infarction in 95 (60.3%), ST-elevation myocardial infarction (STEMI) in 52 (32.7%), and cardiac arrest in 11 (6.9%). Left ventricular function in SCAD-survivors was generally well preserved with small reductions in ejection fraction (57 ± 7.2% vs. 60 ± 4.9%, P < 0.01) and increases in left ventricular dimensions (end-diastolic volume: 85 ± 14 mL/m2 vs. 80 ± 11 mL/m2, P < 0.05; end-systolic volume: 37 ± 11 mL/m2 vs. 32 ± 7 mL/m2, P <0.01) compared to healthy controls. Infarcts were small with few large infarcts (median 4.06%; range 0-30.9%) and 39% having no detectable late gadolinium enhancement (LGE). Female SCAD patients presenting with STEMI had similar sized infarcts to female Type-1 STEMI patients age <75 years. Multivariate modelling demonstrated STEMI at presentation, initial TIMI 0/1 flow, multivessel SCAD, and a Beighton score >4 were associated with larger infarcts [>10% left ventricular (LV) mass]. CONCLUSION The majority of patients presenting with SCAD have no or small infarctions and preserved ejection fraction. Patients presenting with STEMI, TIMI 0/1 flow, multivessel SCAD and those with features of connective tissue disorders are more likely to have larger infarcts.
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Affiliation(s)
- Abtehale Al-Hussaini
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Ahmed M S E K Abdelaty
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.,Department of Cardiovascular Sciences, Faculty of Medicine, Suez Canal University, km 4.5 Ring road, 41522, Ismailia, Egypt
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Marcos Garcia-Guimaraes
- Department of Cardiology, Hospital Universitario de La Princesa Madrid, Calle Diego de León 62, Madrid, Spain
| | - Diluka Premawardhana
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Charley Budgeon
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Alice Wood
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Nalin Natarajan
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.,Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
| | - Roby Rakhit
- Royal Free Hospital, Pond St, Hampstead, London NW3 2QG, UK.,Institute of Cardiovascular Science University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK
| | - Stephen P Hoole
- Royal Papworth Hospital, Papworth Rd, Cambridge CB2 0AY, UK.,NIHR Cambridge Biomedical Research Centre, Box 277 Hills Road Cambridge CB2 0QQ, UK
| | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol BS2 8HW, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.,Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
| | - Ian Hudson
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Andrew Ladwiniec
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Jan Kovac
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Iain Squire
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - David Adlam
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
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25
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Méndez-Eirín E, Suárez-Ouréns Y, Rodríguez-Fernández JÁ. Spontaneous coronary artery dissection. Rev Clin Esp 2021; 221:297-305. [PMID: 38108498 DOI: 10.1016/j.rce.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022]
Abstract
Spontaneous coronary artery dissection is an underdiagnosed entity. It has been recognized as an important cause of acute coronary syndrome and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. This document provides an exhaustive review of the pathophysiology and etiology of this disease. In addition, we describe the main clinical characteristics of these patients, the diagnostic tests that must be performed, and the most appropriate treatment.
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Affiliation(s)
- E Méndez-Eirín
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España.
| | - Y Suárez-Ouréns
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | - J Á Rodríguez-Fernández
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
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26
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An Autopsy Case of Spontaneous Coronary Artery Dissection With Eosinophilic Coronary Periarteritis and Degeneration of Medial Smooth Muscles. Am J Forensic Med Pathol 2021; 42:387-391. [PMID: 33853104 DOI: 10.1097/paf.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 45-year-old woman with no known medical history died suddenly shortly after complaining of anterior chest discomfort. The autopsy revealed a dissection at the anterior descending branch of the left coronary artery, and eosinophilic adventitial inflammation was observed both in the right coronary artery and in the vicinity of the dissection. Furthermore, there was degeneration of the tunica media in the right coronary artery, and this was thought to be a predissection lesion. In the degenerated area of the tunica media, probable apoptosis of smooth muscle cells was noted, suggesting that the degeneration was not due only to the effect of eosinophilic lytic enzymes. These findings also indicated that eosinophilic infiltration preceded the dissection. Eosinophilic infiltration around the coronary arteries is occasionally observed in cases of sudden death, but although it might be associated with the death, the pathological mechanism is yet to be elucidated. Eosinophilic periarteritis has also been observed around the site of spontaneous coronary artery dissection, although a causal relationship is unproven. The histopathology of this case indicated that the eosinophilic infiltration preceded the dissection. Detailed pathological findings are presented, together with a review of the literature.
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27
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Méndez-Eirín E, Suárez-Ouréns Y, Rodríguez-Fernández JÁ. Spontaneous coronary artery dissection. Rev Clin Esp 2021; 221:297-305. [PMID: 33998517 DOI: 10.1016/j.rceng.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/12/2020] [Indexed: 10/21/2022]
Abstract
Spontaneous coronary artery dissection is an underdiagnosed entity. It has been recognized as an important cause of acute coronary syndrome and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. This document provides an exhaustive review of the pathophysiology and etiology of this disease. In addition, we describe the main clinical characteristics of these patients, the diagnostic tests that must be performed, and the most appropriate treatment.
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Affiliation(s)
- E Méndez-Eirín
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Y Suárez-Ouréns
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - J Á Rodríguez-Fernández
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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28
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Calderone D, Capodanno D. Acute coronary syndrome with spontaneous coronary artery dissection: which therapeutic option for a different pathophysiology? Eur Heart J Suppl 2021; 22:L33-L37. [PMID: 33654464 PMCID: PMC7904087 DOI: 10.1093/eurheartj/suaa130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) has been recognized as an emergent cause of acute coronary syndrome (ACS), myocardial infarction, and sudden death. Patients mostly affected by SCAD are individuals without or with few cardiovascular risk factors, particularly young women, thus suggesting a clearly different pathophysiology than the more common atherosclerosis. Present research efforts outlined an improved characterization of the prevalence, natural history, and clinical outcome of SCAD. Intracoronary imaging has been an important asset in this condition, providing an improved diagnostic and therapeutic understanding. Current evidences suggest not only that this condition is more common than previously thought but also that the clinical management could be distinctly different from ACS secondary to atherosclerosis. Both medical and interventional treatment should consider the different cause of ACS, as well as the clinical stability of the patient, taking into account that the risk of recurrence is particularly high, predominantly during the first few days after the acute event. Stemming from new scientific evidences in terms of pathophysiology, clinical approach, therapy strategies, and follow-up of SCAD, it is important to identify spontaneous coronary dissection in the differential diagnosis of ACS.
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Affiliation(s)
- Dario Calderone
- Divisione di Cardiologia, A.O.U. "Policlinico-Vittorio Emanuele", Università degli Studi di Catania, Catania, Italy
| | - Davide Capodanno
- Divisione di Cardiologia, A.O.U. "Policlinico-Vittorio Emanuele", Università degli Studi di Catania, Catania, Italy
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29
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Mohamed A, Gogola L, Dastidar A. Chest pain with elevated troponin in a middle-aged man. BRITISH HEART JOURNAL 2021. [DOI: 10.1136/heartjnl-2020-318639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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30
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Spontaneous coronary artery dissection: Overview of pathophysiology. Trends Cardiovasc Med 2021; 32:92-100. [PMID: 33453416 DOI: 10.1016/j.tcm.2021.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/16/2022]
Abstract
The growing use of imaging examinations has led to increased detection of spontaneous coronary artery dissection (SCAD) as a non-atherosclerotic cause of acute coronary syndrome (ACS). Since a greater awareness of pathophysiologic mechanisms has relevant implications in clinical practice, we aim to provide an update to current knowledge of SCAD pathophysiology. We discuss the most common conditions associated with SCAD, including predisposing factors and triggers, and focus on potential mechanisms leading to SCAD development. Furthermore, we report the main genetic research findings that have shed further light on SCAD pathophysiology. Finally, we summarize practical considerations in SCAD management based on pathophysiologic insights.
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31
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McAlister CP, Yi M, Adamson PD, Troughton RW, Rhodes M, Blake JW, McClean DR, Elliott JM, Smyth DW, Puri A. Trends in the Detection, Management and 30-Day Outcomes of Spontaneous Coronary Artery Dissection: A Six-Year, New Zealand Centre Experience. Heart Lung Circ 2021; 30:78-85. [DOI: 10.1016/j.hlc.2020.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 01/04/2023]
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32
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Gómez-Hospital JA, Ariza-Solé A. Disección coronaria espontánea: ¿es siempre una entidad benigna? Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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33
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Affiliation(s)
- Esther S H Kim
- From the Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville
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34
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Gupta S, Meyersohn NM, Wood MJ, Steigner ML, Blankstein R, Ghoshhajra BB, Hedgire SS. Role of Coronary CT Angiography in Spontaneous Coronary Artery Dissection. Radiol Cardiothorac Imaging 2020; 2:e200364. [PMID: 33778640 PMCID: PMC7978024 DOI: 10.1148/ryct.2020200364] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/30/2020] [Accepted: 09/25/2020] [Indexed: 05/04/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is more common than previously thought and is present in up to 4% of patients presenting with acute coronary syndrome. SCAD predominantly occurs in relatively young women and is an important cause of myocardial infarction in young patients without traditional risk factors of atherosclerotic coronary artery disease. There have been substantial improvements in spatial and temporal resolution and reduction in ionizing radiation dose with new generation scanners. The risk of dissection propagation with an invasive coronary angiogram, improved CT scanner parameters, and predominantly conservative management of SCAD make coronary CT angiography a useful noninvasive imaging modality for the assessment of SCAD. © RSNA, 2020.
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35
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Zilio F, Muraglia S, Morat F, Borghesi M, Todaro D, Menotti A, Dallago M, Braito G, Bonmassari R. Sex differences in clinical and angiographic characteristics in spontaneous coronary artery dissection. Future Cardiol 2020; 17:669-675. [PMID: 33078958 DOI: 10.2217/fca-2020-0124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, mostly in women; however, differences between the sexes should be investigated. Materials & methods: Hundred consecutive patients affected by SCAD were identified; coronary lesions were classified according to the most recent classification and clinical and angiographic data of men and women were compared. Results: Men were significantly younger than women, with more cardiovascular risk factors. Lesions were prevalently classified as type 2A, type 2B or type 1; an angiographic pattern compatible with the presence of an intimal tear (types 1 and 1/2) was more represented in males. Conclusion: Sex-related differences in clinical and angiographic characteristics could help in shedding light on mechanisms that contribute to SCAD.
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Affiliation(s)
- Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy
| | - Simone Muraglia
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy
| | - Fabiola Morat
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy
| | - Marco Borghesi
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy
| | - Daniel Todaro
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy
| | - Alberto Menotti
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy
| | - Michele Dallago
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy
| | - Giuseppe Braito
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy
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36
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Modaragamage Dona AC, Abuelgasim E, Abuelgasim B, Kermali M, Zahra SA, Hewage S, Harky A. Dissection of coronary artery: A clinical overview. J Cardiol 2020; 77:353-360. [PMID: 32994072 DOI: 10.1016/j.jjcc.2020.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare but life-threatening disorder. SCAD is gaining importance as an emerging cause of acute coronary syndrome (ACS), especially in otherwise healthy young women. While SCAD and ACS show similarity in presentation, the management of SCAD differs to that of ACS. If not managed properly SCAD can lead to sudden death. This review examines the pathophysiology, clinical presentation, diagnostic algorithms, and the current and future management of SCAD.
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Affiliation(s)
| | - Eyad Abuelgasim
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Muhammed Kermali
- Faculty of Medicine, St George's, University of London, London, United Kingdom
| | - Syeda Anum Zahra
- Faculty of Medicine, St George's, University of London, London, United Kingdom
| | - Savini Hewage
- Faculty of Medicine, St George's, University of London, London, United Kingdom
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
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37
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Spontaneous coronary artery dissection: a benign entity? ACTA ACUST UNITED AC 2020; 74:2-4. [PMID: 32739145 DOI: 10.1016/j.rec.2020.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 11/23/2022]
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Kim ESH, Tweet MS. Spontaneous Coronary Artery Dissection: A Call for Consensus and Research Advancement. J Am Coll Cardiol 2020; 74:1301-1303. [PMID: 31488266 DOI: 10.1016/j.jacc.2019.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Esther S H Kim
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee.
| | - Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. https://twitter.com/marysia_tweet
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Abstract
This article is a comprehensive document on the diagnosis and management of fibromuscular dysplasia (FMD) which was commissioned by the Working Group 'Hypertension and the Kidney' of the European Society of Hypertension (ESH) and the Society for Vascular Medicine (SVM). This document updates previous consensus documents/scientific statements on FMD published in 2014 with full harmonization of the position of European and US experts. In addition to practical consensus-based clinical recommendations, including a consensus protocol for catheter-based angiography and percutaneous angioplasty for renal FMD, the document also includes the first analysis of the European/International FMD Registry and provides updated data from the US Registry for FMD. Finally, it provides insights on ongoing research programs and proposes future research directions for understanding this multifaceted arterial disease.
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Garcia-Guimarães M, Bastante T, Antuña P, Jimenez C, de la Cuerda F, Cuesta J, Rivero F, Premawardhana D, Adlam D, Alfonso F. Spontaneous Coronary Artery Dissection: Mechanisms, Diagnosis and Management. Eur Cardiol 2020; 15:1-8. [PMID: 32256714 PMCID: PMC7113739 DOI: 10.15420/ecr.2019.01] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a relatively infrequent cause of acute coronary syndrome that usually affects young to middle-aged women. Mainly because of its low prevalence, until recently, most of the evidence on this condition was derived from case reports and small series. Over the last 5 years, more robust evidence has become available from larger retrospective and prospective cohorts of patients with SCAD. The increase in knowledge and recognition of this entity has led to the publication of expert consensus on both sides of the Atlantic. However, new data are continuously accumulating from larger cohorts of patients with SCAD, bringing new light to this little-understood condition. The aim of this article is to update the knowledge on SCAD, including new information from recent studies published since the consensus documents from the European Society of Cardiology and the American Heart Association.
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Affiliation(s)
- Marcos Garcia-Guimarães
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Glenfield General Hospital, Leicester, UK
| | - Teresa Bastante
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Paula Antuña
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - César Jimenez
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Francisco de la Cuerda
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Cuesta
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - David Adlam
- Cardiology Department, Glenfield General Hospital, Leicester, UK
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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McLean ME, Beck-Esmay J. Fitting a Square Peg in a Round Hole: A Simple Case of Chest Pain. Clin Pract Cases Emerg Med 2020; 4:1-7. [PMID: 32064413 PMCID: PMC7012552 DOI: 10.5811/cpcem.2019.10.44141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/13/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022] Open
Abstract
A 39-year-old female presents to the emergency department with chest pain and shortness of breath. Her electrocardiogram suggests ST-elevation myocardial infarction, but she has no atherosclerotic risk factors. She is gravida 4, para 4, and four weeks postpartum from uncomplicated vaginal delivery. She is diaphoretic and anxious, but otherwise her exam is unremarkable. Cardiac enzymes are markedly elevated and point-of-care echocardiogram shows inferolateral hypokinesis and ejection fraction of 50%. In this clinicopathological case, we explore a classically underappreciated cause of acute coronary syndrome in healthy young women.
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Affiliation(s)
- Mary E McLean
- St. John's Riverside Hospital, Department of Emergency Medicine, Yonkers, New York
| | - Jennifer Beck-Esmay
- Mount Sinai St. Luke's-Mt Sinai West, Department of Emergency Medicine, New York, New York
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42
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Jamil A, Tajrishi FZ, Kahe F, Najafi H, Montazerin SM, Shojaei F, Chitsazan M, Chitsazan M, Liu Y, Chi G. Spontaneous coronary artery dissection managed with a conservative or revascularization approach. J Cardiovasc Med (Hagerstown) 2020; 21:42-50. [DOI: 10.2459/jcm.0000000000000891] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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43
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Spontaneous Coronary Artery Dissection. JACC Cardiovasc Imaging 2019; 12:2475-2488. [DOI: 10.1016/j.jcmg.2019.01.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/20/2018] [Accepted: 01/04/2019] [Indexed: 11/18/2022]
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44
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Adlam D, Olson TM, Combaret N, Kovacic JC, Iismaa SE, Al-Hussaini A, O'Byrne MM, Bouajila S, Georges A, Mishra K, Braund PS, d'Escamard V, Huang S, Margaritis M, Nelson CP, de Andrade M, Kadian-Dodov D, Welch CA, Mazurkiewicz S, Jeunemaitre X, Wong CMY, Giannoulatou E, Sweeting M, Muller D, Wood A, McGrath-Cadell L, Fatkin D, Dunwoodie SL, Harvey R, Holloway C, Empana JP, Jouven X, Olin JW, Gulati R, Tweet MS, Hayes SN, Samani NJ, Graham RM, Motreff P, Bouatia-Naji N. Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Coronary Artery Dissection. J Am Coll Cardiol 2019; 73:58-66. [PMID: 30621952 PMCID: PMC10403154 DOI: 10.1016/j.jacc.2018.09.085] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene. OBJECTIVES This study sought to test the association between the rs9349379 genotype and SCAD. METHODS Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD. RESULTS The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval [CI]: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence. CONCLUSIONS The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD.
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Affiliation(s)
- David Adlam
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.
| | - Timothy M Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nicolas Combaret
- Department of Cardiology, University Hospital of Clermont-Ferrand, Auvergne University, Clermont-Ferrand, France
| | - Jason C Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, Marie-Josée and Henry R. Kravis Cardiovascular Health Center at Mount Sinai, New York, New York
| | - Siiri E Iismaa
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Abtehale Al-Hussaini
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Megan M O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Sara Bouajila
- Department of Cardiology, University Hospital of Clermont-Ferrand, Auvergne University, Clermont-Ferrand, France
| | - Adrien Georges
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
| | - Ketan Mishra
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Peter S Braund
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Valentina d'Escamard
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, Marie-Josée and Henry R. Kravis Cardiovascular Health Center at Mount Sinai, New York, New York
| | - Siying Huang
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
| | - Marios Margaritis
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Mariza de Andrade
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Daniella Kadian-Dodov
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, Marie-Josée and Henry R. Kravis Cardiovascular Health Center at Mount Sinai, New York, New York
| | - Catherine A Welch
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Stephani Mazurkiewicz
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
| | - Xavier Jeunemaitre
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France; Department of Genetics, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Claire Mei Yi Wong
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Eleni Giannoulatou
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Michael Sweeting
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - David Muller
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Alice Wood
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Lucy McGrath-Cadell
- St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Diane Fatkin
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Sally L Dunwoodie
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Richard Harvey
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Cameron Holloway
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Jean-Philippe Empana
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
| | - Xavier Jouven
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
| | - Jeffrey W Olin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, Marie-Josée and Henry R. Kravis Cardiovascular Health Center at Mount Sinai, New York, New York
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Robert M Graham
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Pascal Motreff
- Department of Cardiology, University Hospital of Clermont-Ferrand, Auvergne University, Clermont-Ferrand, France
| | - Nabila Bouatia-Naji
- INSERM, Paris Cardiovascular Research Center, Paris, France; Faculty of Medicine, Paris-Descartes University, Sorbonne Paris Cité, Paris, France.
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Zhukova NS, Shakhnovich RM, Merkulova IN, Sukhinina TS, Pevzner DV, Staroverov II. [Spontaneous Coronary Artery Dissection]. ACTA ACUST UNITED AC 2019; 59:52-63. [PMID: 31540576 DOI: 10.18087/cardio.2019.9.10269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
During several recent decades spontaneous coronary artery dissection (SCAD) has been known as one of causes of development of acute coronary syndrome (ACS). It has been assumed that this condition is extremely rarely met and is associated with pregnancy and postpartum period. The use in clinical practice of high sensitivity troponin, coronary angiography (CAG) in early period of ACS, in conjunction with the growing awareness of doctors about this pathology led to a revision of the viewse on prevalence of the disease. At present SCAD is considered as one of the causes of ACS in young and middle-aged women. In this review we present results of studies of pathogenesis, diagnostics, and treatment of SCAD, describe various angiographic types of this disease, and discuss problems of choice of optimal strategy of management of patients with SCAD.
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Affiliation(s)
- N S Zhukova
- National Medical Research Center for Cardiology
| | | | | | | | - D V Pevzner
- National Medical Research Center for Cardiology
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46
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Cerrato E, Giacobbe F, Rolfo C, Quadri G, Tomassini F, Ferrari F, Mariani F, Anselmino M, Bianco M, Belliggiano D, Savio LL, Franzé A, Barbero U, Porto I, Mejía-Rentería H, Macaya F, Salinas P, Gonzalo N, Escaned J, Montagna L, Varbella F. Role of Invasive and Non-invasive Imaging Tools in the Diagnosis and Optimal Treatment of Patients with Spontaneous Coronary Artery Dissection. Curr Cardiol Rep 2019; 21:122. [DOI: 10.1007/s11886-019-1202-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Lobo AS, Cantu SM, Sharkey SW, Grey EZ, Storey K, Witt D, Benson G, Garberich RF, Kubota Y, Bairey Merz CN, Henry TD. Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2019; 74:1290-1300. [DOI: 10.1016/j.jacc.2019.06.065] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023]
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48
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Tsanaxidis N, Elshafie S, Munir S. Spontaneous coronary artery dissection in a patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy syndrome: a case report. Eur Heart J Case Rep 2019; 3:ytz136. [PMID: 31660501 PMCID: PMC6764544 DOI: 10.1093/ehjcr/ytz136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/11/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
Background Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) syndrome is a genetically inherited condition most notably affecting the central nervous system in young adults. There is limited knowledge on its association with coronary arteries, and its association with spontaneous coronary artery dissection (SCAD) has not been previously reported. Case summary A 61-year-old woman who is known to have CADASIL syndrome presented with anterior ST-segment myocardial infarction and underwent emergency angiography. This showed appearance consistent with SCAD in the mid left anterior descending artery with tubular stenosis. Discussion The association between CADASIL syndrome and SCAD has not been previously reported. The similarity in the underlying pathophysiology of these two conditions makes this case intriguing.
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Affiliation(s)
- Nikolaos Tsanaxidis
- Cardiology Department, Wolverhampton Heart and Lung Centre, New Cross Hospital, Wolverhampton Road, Wolverhampton WV10 0QP, UK
| | - Sally Elshafie
- Cardiology Department, Wolverhampton Heart and Lung Centre, New Cross Hospital, Wolverhampton Road, Wolverhampton WV10 0QP, UK
| | - Shahzad Munir
- Cardiology Department, Wolverhampton Heart and Lung Centre, New Cross Hospital, Wolverhampton Road, Wolverhampton WV10 0QP, UK
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49
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Spontaneous coronary artery dissections and fibromuscular dysplasia: Current insights on pathophysiology, sex and gender. Int J Cardiol 2019; 286:220-225. [DOI: 10.1016/j.ijcard.2018.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 12/14/2022]
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50
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Hart K, Patel S, Kovoor J. Spontaneous Coronary Artery Dissection Associated with Anal Cancer Management with Fluorouracil and Radiotherapy. Cureus 2019; 11:e4979. [PMID: 31467813 PMCID: PMC6706264 DOI: 10.7759/cureus.4979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is thought to be a rare condition that is hard to predict due to the lack of easily identifiable warning signs. We report the case of a 49-year-old woman with a locally advanced Stage IIIB anal squamous cell carcinoma who presented with chest pain and a positive stress test, ST elevations in her inferior echocardiogram leads, and induced chest pain with exercise without heart perfusion defects. Coronary catheterization revealed a right coronary artery dissection, which led to the diagnosis of SCAD. Our patient was diagnosed while undergoing a combination treatment of fluorouracil (5-FU), mitomycin, and pelvic radiotherapy. We reviewed the current literature and update the etiologies that have been proposed since the publication of this case report.
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Affiliation(s)
- Kimberly Hart
- Radiation Oncology, The Karmanos Cancer Center's Gershenson Radiation Oncology Center, Wayne State University School of Medicine, Detroit, USA
| | - Suketu Patel
- Radiation Oncology, The Karmanos Cancer Center's Gershenson Radiation Oncology Center, Wayne State University School of Medicine, Detroit, USA
| | - Joshua Kovoor
- Radiation Oncology, The Karmanos Cancer Center's Gershenson Radiation Oncology Center, Wayne State University School of Medicine, Detroit, USA
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