Canadian Spontaneous Coronary Artery Dissection Cohort Study

Saw, Jacqueline; Starovoytov, Andrew; Aymong, Eve; Inohara, Taku; Alfadhel, Mesfer; McAlister, Cameron; Samuel, Rohit; Grewal, Tejana; Parolis, Johandra Argote; Sheth, Tej; So, Derek; Minhas, Kunal; Brass, Neil; Lavoie, Andrea; Bishop, Helen; Lavi, Shahar; Pearce, Colin; Renner, Suzanne; Madan, Mina; Welsh, Robert C.; McGrath, Brent M.; Vijayaraghavan, Ram; Har, Bryan; Ibrahim, Réda; Chaudhary, Pulkit; Ganesh, Santhi K.; Graham, John M.; Matteau, Alexis; Martucci, Giuseppe; Ko, Dennis T.; Humphries, Karin H.; Mancini, GB John

doi:10.1016/j.jacc.2022.08.759

Cited by 67 publications

(93 citation statements)

References 20 publications

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“…First, much of the previous data come from prospective studies and SCAD registries in which patients are routinely followed by SCAD experts, who are more likely to order comprehensive vascular imaging. 11 , 12 , 19 , 23 The present study more accurately reflects real-world clinical practice because it includes any patient treated within Penn Medicine, some of whom were subsequently followed outside of the health system at community practices. The lower rate of vascular imaging in this study may be compounded by loss to follow-up.…”

Section: Discussionmentioning

confidence: 99%

“… 24 A recent large, prospective, cohort study also demonstrated that FMD is a predictor of future major adverse cardiac events in patients with SCAD. 12 Diagnosing patients with FMD and other extracoronary vascular abnormalities may impact prognosis, medical management, lifestyle counseling, and suggested family screening.…”

Section: Discussionmentioning

confidence: 99%

“…There have been no randomized controlled trials of SCAD management, but an increasing number of cohort studies published between 2012 and 2022 demonstrate that SCAD may be optimally managed via a conservative approach rather than coronary revascularization (percutaneous intervention or coronary artery bypass graft surgery [CABG]) in cases without ongoing chest pain, cardiogenic shock, arrhythmia, or left main artery dissection. 1 – 3 , 8 – 12 A conservative approach is further supported by high rates of spontaneous dissection healing and a higher failure rate from PCI in SCAD compared to atherosclerotic ACS. 3 , 9 , 13 , 14 However, optimal medical therapy is not well defined.…”

Section: Introductionmentioning

confidence: 99%

“…One study suggested that beta-blockers decrease the risk of recurrence, but this has not been shown in other cohorts. 12 , 15 , 16 Similarly, the benefit of dual antiplatelet therapy (DAPT) is unclear given the difference in pathophysiologic mechanisms between SCAD and atherosclerotic ACS and lack of clinical trials demonstrating benefit. 6 …”

Section: Introductionmentioning

confidence: 99%

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Management of spontaneous coronary artery dissection: Trends over time

et al. 2023

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Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome. Guidance regarding the optimal management of patients with SCAD has been published over the past 10 years, but the impact on clinical practice has not been evaluated. The present study aims to examine if approaches to invasive management, medical therapy, and vascular imaging have changed over time. Methods: This is a retrospective cohort study of 157 patients treated for SCAD between 2005 and 2019 at an academic health system in Philadelphia, Pennsylvania. We aimed to examine change in management over time, including rates of coronary revascularization, discharge medications, and vascular imaging. Results: Conservative management of SCAD increased over time from 35% before 2013 to 89% in 2019, p < 0.001. Revascularization was associated with younger age, pregnancy-associated SCAD, and lesions of the left main artery, left anterior descending artery, and multiple vessels, p < 0.05 for all. Partial imaging for extracoronary vascular abnormalities ranged from 33% before 2013 to 71% in 2018, p = 0.146. The rate of comprehensive vascular imaging (cross-sectional head to pelvis imaging) remained low in all time categories (10–18%) and did not change over time. Patients who underwent comprehensive imaging were more likely to be diagnosed with fibromuscular dysplasia (FMD) compared to those with partial imaging (63% vs 15%, p < 0.001). Conclusion: Management of spontaneous coronary artery dissection has changed over time. More patients are being managed conservatively and undergo screening for extracoronary vascular abnormalities such as FMD. Future efforts should focus on improving rates of comprehensive vascular screening.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of spontaneous coronary artery dissection: Trends over time

et al. 2023

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“…2,3 Genetic disorders, peripartum SCAD, and FMD were independent predic- tors of 3-year adverse cardiac events. 4 Although mortality is low, onefourth of patients with SCAD had recurrent SCAD.…”

Section: Discussionmentioning

confidence: 99%

Management of Postpartum Left Main Spontaneous Coronary Artery Dissection

2023

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Spontaneous coronary artery dissection (SCAD): A contemporary review

Offen,

Yang,

Saw

2024

Clinical Cardiology

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Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction that most frequently affects younger women, making it an important cause of morbidity and mortality within these demographics. The evolution of intracoronary imaging, improved diagnosis with coronary angiography, and ongoing research efforts and attention via social media, has led to increasing recognition of this previously underdiagnosed condition. In this review, we provide a summary of the current body of knowledge, as well as focused updates on the pathogenesis of SCAD, insights on genetic susceptibility, contemporary diagnostic tools, and immediate, short‐ and long‐term management.

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Canadian Spontaneous Coronary Artery Dissection Cohort Study

Cited by 67 publications

References 20 publications

Management of spontaneous coronary artery dissection: Trends over time

Management of spontaneous coronary artery dissection: Trends over time

Management of Postpartum Left Main Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD): A contemporary review

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