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Brunton N, Best PJM, Skelding KA, Cendrowski EE. Spontaneous Coronary Artery Dissection (SCAD) from an Interventionalist Perspective. Curr Cardiol Rep 2024; 26:91-96. [PMID: 38236518 PMCID: PMC10991027 DOI: 10.1007/s11886-023-02019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS), particularly among women < 50 years of age. Here, we aim to review the pathogenesis of SCAD, discuss SCAD as an initial manifestation of systemic arterial disease, and highlight invasive strategies as well as unique challenges in the care of women with SCAD. RECENT FINDINGS A paradigm shift has occurred in the care of SCAD patients in the past decade as recommendations for conservative management have become widespread. Invasive interventions are reserved for patients with hemodynamic compromise or active ischemia due to increased periprocedural complications and failure rates. Certain patient populations have been identified for larger territory infarcts and proximal disease including patients with known connective tissue disease, premenopausal women, and patients with pregnancy-associated SCAD (P-SCAD). Current recommended management of SCAD is conservative. Despite a growing awareness of SCAD and its known association with systemic arteriopathies in women, evidence-based data remains scarce. Future studies focused on identifying genetic factors, optimal medical therapy after SCAD, and techniques to minimize interventional complications are needed.
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Affiliation(s)
- Nichole Brunton
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Patricia J M Best
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
| | | | - Emily E Cendrowski
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
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Alabdaljabar MS, Cendrowski EE, Nishimura RA, Miranda WR, Geske JB, Rihal CS, Eleid MF. Hemodynamic Predictors of Outcome Following Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy. Circ Cardiovasc Interv 2023; 16:e013068. [PMID: 37582173 PMCID: PMC10424819 DOI: 10.1161/circinterventions.123.013068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Alcohol septal ablation (ASA) is a minimally invasive treatment for drug-refractory obstructive hypertrophic cardiomyopathy. Detailed assessment of pressure changes and predictors of mortality and procedure success are not well defined. METHODS This is a single-center study evaluating pressure changes and predictors of mortality and procedure success in transseptal ASA. Survival analysis and predictors of mortality were assessed using the Kaplan-Meier analysis and Cox regression, respectively. RESULTS A total of 156 patients were included (mean age, 67.3 years; 46.8% women). Left atrial (LA) pressure and left ventricular outflow tract (LVOT) gradient decreased, whereas aortic pulse pressure (PP) increased post-ASA. Patients with lower baseline mean LA pressure ( 82% (gradient change median), and PP increase >19% (PP change median) had superior survival. On Cox univariable regression, baseline mean LA pressure >median (19 mm Hg; hazard ratio [HR], 2.09 [95% CI, 1.05-4.18]; P=0.036), residual LVOT gradient (HR, 1.02 [95% CI, 1.01-1.03]; P=0.003), and LVOT gradient percent reduction median (28 mm Hg; HR, 2.36 [95% CI, 1.17-4.76]; P=0.016), baseline mean LA pressure >median (19 mm Hg; HR, 2.70 [95% CI, 1.33-5.50]; P=0.006), percentage reduction in gradient CONCLUSIONS ASA is associated with an acute decrease in the LVOT gradient and LA pressures and increase in aortic PP. Mean LA pressure, percentage decrease in LVOT gradient, and increase in PP are strong predictors of survival free of all-cause mortality following ASA and are important variables for procedural guidance.
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Affiliation(s)
| | - Emily E. Cendrowski
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
| | - Rick A. Nishimura
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
| | - William R. Miranda
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
| | - Jeffrey B. Geske
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
| | - Charanjit S. Rihal
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
| | - Mackram F. Eleid
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
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