Spontaneous coronary artery dissection and ST-segment elevation myocardial infarction: Does clinical presentation matter?
Int J Cardiol
; 373: 1-6, 2023 02 15.
Article
in En
| MEDLINE
| ID: mdl-36435331
ABSTRACT
BACKGROUND:
Some patients with spontaneous coronary artery dissection (SCAD) present as ST-segment-elevation myocardial infarction (STEMI). This study evaluates the characteristics, management and outcomes of SCAD patients presenting as STEMI compared to non-ST-segment elevation myocardial infarction (NSTEMI).METHODS:
We analysed data from consecutive patients included in the prospective Spanish Registry on SCAD. All coronary angiograms were centrally reviewed. All adverse events were adjudicated by an independent Clinical Events Committee.RESULTS:
Between June 2015 to December 2020, 389 patients were included. Forty-two percent presented with STEMI and 56% with NSTEMI. STEMI patients showed a worse distal flow (TIMI flow 0-1 38% vs 19%, p < 0.001) and more severe (% diameter stenosis 85 ± 18 vs 75 ± 21, p < 0.001) and longer (42 ± 23 mm vs 35 ± 24 mm, p = 0.006) lesions. Patients with STEMI were more frequently treated with percutaneous coronary intervention (PCI) (31% vs 16%, p < 0.001) and developed more frequently left ventricular systolic dysfunction (21% vs 8%, p < 0.001). No differences were found in combined major adverse events during admission (7% vs 5%, p = 0.463), but in-hospital reinfarctions (5% vs 1.4%, p = 0.039) and cardiogenic shock (2.6% vs 0%, p = 0.019) were more frequently seen in the STEMI group. At late follow-up (median 29 months) no differences were found in the incidence of major adverse cardiac and cerebrovascular events (13% vs 13%, p-value = 0.882) between groups.CONCLUSIONS:
Patients with SCAD and STEMI had a worse angiographic profile and were more frequently referred to PCI compared to NSTEMI patients. Despite these disparities, both short and long-term prognosis were similar in STEMI and NSTEMI SCAD patients.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Percutaneous Coronary Intervention
/
Non-ST Elevated Myocardial Infarction
/
ST Elevation Myocardial Infarction
Type of study:
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
Int J Cardiol
Year:
2023
Document type:
Article
Affiliation country:
Spain