Characteristics, Management, and Prognosis of Spontaneous Coronary Intramural Hematoma

Abstract

Spontaneous coronary intramural hematoma (SCIH) was one type of spontaneous coronary artery dissection without obvious intimal tear, which is easy to misdiagnose. We aimed to study the characteristics, management, and prognosis of SCIH in our center. All the SCIH patients (n = 30) diagnosed by coronary angiography from January 1, 2012 to December 31, 2018 were enrolled. The demographic characteristics, history, therapy, and follow-up were collected. The mean age of the patients was 51.8 ± 9.5 years. Most of the patients were females (66.7%) with hypertension. Patients with diffuse lesion, focal lesion, and multiple vessels were 70%, 13.3%, and 16.7%, respectively. Conservative treatment was the first choice (76.7%). The mean follow-up time was 29.3 ± 13.5 months. None of the patients had unplanned readmission due to worsening symptoms. Nine patients underwent coronary artery computed tomography reexamination after 10.3 ± 7.5 months, which showed complete recovery of SCIH. Eight patients were hospitalized for coronary angiography 6.4 ± 4.7 months later, which did not show any sign of SCIH. Spontaneous coronary intramural hematoma was most common in post-menopausal women with hypertension. Possibly, antiplatelet drugs should be avoided in SCIH. Waiting for the hematoma to heal was preferable and had a good prognosis.

Chest Pain and the Dynamic Evolution of Spontaneous Coronary Artery Hematoma

“…This contrasts with the so-called “inside-out” (or intimal tear) hypothesis, which considers the primary mechanism of SCAD to be the initial disruption of the intimal luminal interface with penetration of blood inside the false lumen for intramural hematoma accumulation. 3 , 5 In our case, the absence of an intimal tear visualized by intracoronary imaging clearly supports the “outside-in” pathophysiologic hypothesis of SCAD.…”

Regional and temporal variations of spontaneous coronary artery dissection care according to consensus recommendations: a systematic review and meta-analysis

“…Two studies reported the mean time from symptoms onset to angiogram, with one reported 95% CI (24 hours (4–48)) 9 and the other reported standard deviation (7±5.4 days). 10 In another study, 11 door-to-balloon time was reported with the difference between patients with SCAD and other causes of AMI being not statistically significant (median 142 min for SCAD vs 99 min for other AMI, p=0.301). Due to heterogeneity, meta-analysis was not performed for this parameter.…”

“…Before 2018, there were only 15 studies (n=1065), compared with 39 studies (n=7509) after 2018. The majority of included studies were retrospective (28), followed by prospective (12), cross-sectional (10) and mixed-method (4) studies.…”

Recurrent spontaneous coronary artery dissection

“…Currently, most trials are observational and nonrandomized, and there is insufficient evidence to support an optimal antiplatelet strategy for patients not receiving PCI. On the one hand, antiplatelet therapy prevents thrombosis caused by intimal dissection; on the other hand, it may lead to hematoma progression or delayed resorption [2,53]. Some experts have suggested that DAPT might be considered during the acute SCAD phase and for up to 1 year for stable patients [1,2,47].…”