Revascularization and long-term outcomes in high-acuity spontaneous coronary artery dissection.
Catheter Cardiovasc Interv
; 100(7): 1229-1241, 2022 12.
Article
en En
| MEDLINE
| ID: mdl-36273416
ABSTRACT
BACKGROUND:
Spontaneous coronary artery dissection (SCAD) is often treated conservatively due to revascularization risks. Yet, an important number of SCAD patients have high acuity characteristics necessitating revascularization, with uncertain long-term outcomes.OBJECTIVES:
Document revascularization utilization and long-term outcomes in high acuity SCAD.METHODS:
Prospective/retrospective analysis of consecutive patients with acute myocardial infarction (AMI) due to first SCAD event presenting directly to the Minneapolis Heart Institute 2002-2021, median follow-up 3.8 years.RESULTS:
Among 139 patients (age 49 ± 12 years, 96% female), revascularization was performed in 60 (43%), utilizing percutaneous coronary intervention (PCI) (n = 56, successful in 80%) or coronary artery bypass graft (n = 4). In the entire cohort, 90 (65%) unique patients had one or more high acuity characteristic ST-elevation (38%), proximal dissection (38%), cardiogenic shock (6.5%), cardiac arrest (9.4%), left main dissection (6.5%), peripartum dissection (7.2%). High acuity patients accounted for 51 of 60 (85%) revascularizations. Revascularization rates were ST-elevation (60%), proximal dissection (62%), cardiogenic shock (89%), cardiac arrest (62%), left main dissection (100%), peripartum dissection (70%). Survival was 97% (revascularized) vs 100% (nonrevascularized); p = 0.2. Adverse outcomes (revascularized vs. nonrevascularized) included recurrent AMI16.7% versus 8.9%; p = 0.2, SCAD recurrence 13.3% versus 6.3%; p = 0.1, stroke 5% versus 2.5%; p = 0.44, implantable cardioverter-defibrillator 6.7% versus 6.3%; p > 0.9. Reintervention was necessary in 21% of PCI-treated patients.CONCLUSIONS:
High-acuity characteristics were present in nearly two-thirds of this SCAD cohort; the vast majority of revascularizations were performed in high-acuity patients. Despite high acuity, long-term survival was favorable in revascularized patients.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Anomalías de los Vasos Coronarios
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Intervención Coronaria Percutánea
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Infarto del Miocardio con Elevación del ST
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Paro Cardíaco
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Infarto del Miocardio
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Catheter Cardiovasc Interv
Asunto de la revista:
CARDIOLOGIA
Año:
2022
Tipo del documento:
Article
País de afiliación:
Estados Unidos