Dissection of coronary artery: A clinical overview

Dona, Ann Christine Modaragamage; Abuelgasim, Eyad; Abuelgasim, Biyaser; Kermali, Muhammed; Zahra, Syeda Anum; Hewage, Savini; Harky, Amer

doi:10.1016/j.jjcc.2020.08.011

Cited by 8 publications

(12 citation statements)

References 72 publications

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“…SCAD can manifest as angina pectoris, ACS, or even sudden cardiac death. It is now estimated that SCAD is the underlying cause of 1.7 to 4% of ACS and accounts for 0.5% of sudden cardiac deaths [3]. SCAD predominantly afflicts young to middle-aged people with few traditional risk factors for ACS.…”

Section: Introductionmentioning

confidence: 99%

Discussion on the causes of thrombolysis failure in a patient with STEMI: a case report

Qiu

Li²,

Yan³

et al. 2022

BMC Cardiovasc Disord

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Background Spontaneous coronary artery dissection (SCAD) has emerged as an increasingly diagnosed cause of ST-segment elevation myocardial infarction (STEMI), which is easily missed or delayed. The effective use of coronary angiography (CAG) and advanced intracoronary imaging examinations in STEMI patients has led to increased detection of SCAD. Case presentation A 59-year-old woman with acute angina pectoris was diagnosed with STEMI detected by electrocardiography combined with measurement of myocardial enzymes. Due to the ongoing pandemic of coronavirus disease 2019 (COVID-19) in Wuhan, she was first given thrombolytic therapy after excluding contraindications according to the requirements of the current consensus statement; however, subsequently, both the symptoms of ongoing chest pain and the electrocardiographic results indicated the failure of thrombolytic therapy, so the intervention team administered rescue percutaneous coronary intervention treatment under third-grade protection. CAG confirmed total occlusion in the distal left anterior descending (LAD) artery, with thrombolysis in myocardial infarction (TIMI) 0 flow, whereas the left circumflex and right coronary arteries appeared normal, with TIMI 3 flow. Intravenous ultrasound (IVUS) was further performed to investigate the causes of occlusion, which verified the absence of atherosclerosis but detected SCAD with intramural haematoma. During the operation, the guidewire reached the distal end of the LAD artery smoothly, the balloon was dilated slightly, and the reflow of TIMI blood could be seen by repeated CAG. During the follow-up period of one and a half years, the patient complained of occasional, slight chest tightness. The repeated CAG showed that the spontaneous dissection in the LAD artery had healed well, with TIMI 3 flow. The repeated IVUS confirmed that the SCAD and intramural haematoma had been mostly resorbed and repaired. Conclusion This was a case of failed STEMI thrombolysis in our hospital during the outbreak of COVID-19. This case indicates that doctors need to consider the cause of the disease when treating STEMI patients, especially patients without traditional cardiovascular risk factors. Moreover, CAG and intracoronary imaging examinations should be actively performed to identify the aetiology and improve the treatment success rate.

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Section: Introductionmentioning

confidence: 99%

Discussion on the causes of thrombolysis failure in a patient with STEMI: a case report

Qiu

Li²,

Yan³

et al. 2022

BMC Cardiovasc Disord

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“…This meta-analysis showed that a non-invasive approach to SCAD treatment is favored for hemodynamically stable patients with NP-SCAD, which confirms the results of previous studies. Although heparin is indicated in patients with ACS, it is recommended to discontinue the anticoagulation therapy after angiographic findings of SCAD to minimize bleeding and enable intramural hematoma to organize ( 46 ).…”

Section: Discussionmentioning

confidence: 99%

“…According to the contemporary guidelines, in SCAD patients undergoing subsequent PCI, dual antiplatelet therapy (DAPT) is recommended. The duration of dual antiplatelet therapy after PCI is recommended during 12 months if patients are not on high bleeding risk ( 46 ). The optimal duration of monotherapy after 12 months in SCAD patients after PCI remains still unknown ( 46 , 47 ).…”

Section: Discussionmentioning

confidence: 99%

“…The duration of dual antiplatelet therapy after PCI is recommended during 12 months if patients are not on high bleeding risk ( 46 ). The optimal duration of monotherapy after 12 months in SCAD patients after PCI remains still unknown ( 46 , 47 ). The use of dual antiplatelet therapy for 12 months, in SCAD patients, was advocated after the publication of studies where in addition to hematoma, an intraluminal thrombus was frequently found on OCT ( 47 ).…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous coronary artery dissection in women in the generative period: clinical characteristics, treatment, and outcome—a systematic review and meta-analysis

Apostolović,

Ignjatović,

Stanojević

et al. 2024

Front. Cardiovasc. Med.

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IntroductionSpontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary arterial wall.Materials and methodsThis systematic review and meta-analysis is reported following the PRISMA guidelines and is registered in the PROSPERO database. A literature search was focused on female patients in generative period (16–55 of age) with acute coronary syndrome (ACS) caused by SCAD, and comparison from that database NP-SCAD (spontaneous coronary artery dissection in non pregnant women) and P-SCAD (spontaneous coronary artery dissection in pregnant women).Results14 studies with 2,145 females in the generative period with ACS caused by SCAD were analyzed. The median age was 41 years (33.4–52.3 years). The most common risk factor was previous smoking history in 24.9% cases. The most common clinical presentation of ACS was STEMI in 47.4%. Conservative treatment was reported in 41.1%. PCI was performed in 32.7%, and 3.8% of patients had CABG surgery. LAD was the most frequently affected (50.5%). The prevalence of composite clinical outcomes including mortality, non-fatal MI and recurrent SCAD was 3.3% (95% CI: 1.4–5.1), 37.7% (95% CI: 1.9–73.4) and 15.2% (95% CI: 9.1–21.3) of patients. P-SCAD compared to NP-SCAD patients more frequently had STEMI (OR = 3.16; 95% CI: 2.30–4.34; I2 = 64%); with the left main and LAD more frequently affected [(OR = 14.34; 95% CI: 7.71–26.67; I2 = 54%) and (OR = 1.57; 95% CI: 1.06–2.32; I2 = 23%)]; P-SCAD patients more frequently underwent CABG surgery (OR = 6.29; 95% CI: 4.08–9.70; I2 = 0%). NP-SCAD compared to P-SCAD patients were more frequently treated conservatevly (OR = 0.61; 95% CI: 0.37–0.98; I2 = 0%). In P-SCAD compared to NP-SCAD mortality rates (OR = 1.13; 95% CI: 0.06–21.16; I2 = not applicable) and reccurence of coronary artery dissection (OR = 2.54; 95% CI: 0.97–6.61; I2 = 0%) were not more prevalent.ConclusionThe results of this meta-analysis indicated that patients with P-SCAD more frequently had STEMI, and events more frequently involved left main and LAD compared to NP-SCAD patients. Women with NP-SCAD were significantly more often treated conservatively compared to P-SCAD patients. P-SCAD compared to NP-SCAD patients did not have significantly higher mortality rates or recurrent coronary dissection.

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“…The basic mechanism leading to myocardial ischemia is rupture of the atherosclerotic plaque in the coronary arteries and the resulting thrombosis [ 56 ]. Other mechanisms of myocardial ischemia resulting from coronary artery pathology include coronary artery spasm [ 57 ] or dissection [ 58 ], as well as coronary embolism [ 59 ]. Ischemic myocardial damage may also result from disproportions between oxygen supply and demand due to conditions such as bradyarrhythmia [ 60 ], tachyarrhythmia [ 61 ], poorly controlled hypertension resulting in left ventricular hypertrophy [ 62 ], respiratory failure [ 63 ], hypotension [ 64 ], shock (different types, both cardiogenic and non-cardiogenic) [ 65 , 66 , 67 ], or severe anemia [ 68 ].…”

Section: Cardiac Troponin Blood Level In Acute Cardiovascular Eventsmentioning

confidence: 99%

Cardiac Troponin Serum Concentration Measurement Is Useful Not Only in the Diagnosis of Acute Cardiovascular Events

Jakubiak

2024

JPM

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Cardiac troponin serum concentration is the primary marker used for the diagnosis of acute coronary syndrome. Moreover, the measurement of cardiac troponin concentration is important for risk stratification in patients with pulmonary embolism. The cardiac troponin level is also a general marker of myocardial damage, regardless of etiology. The purpose of this study is to conduct a literature review and present the most important information regarding the current state of knowledge on the cardiac troponin serum concentration in patients with chronic cardiovascular disease (CVD), as well as on the relationships between cardiac troponin serum concentration and features of subclinical cardiovascular dysfunction. According to research conducted to date, patients with CVDs, such as chronic coronary syndrome, chronic lower extremities’ ischemia, and cerebrovascular disease, are characterized by higher cardiac troponin concentrations than people without a CVD. Moreover, the literature data indicate that the concentration of cardiac troponin is correlated with markers of subclinical dysfunction of the cardiovascular system, such as the intima–media thickness, pulse wave velocity, ankle–brachial index, coronary artery calcium index (the Agatston score), and flow-mediated dilation. However, further research is needed in various patient subpopulations and in different clinical contexts.

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Dissection of coronary artery: A clinical overview

Cited by 8 publications

References 72 publications

Discussion on the causes of thrombolysis failure in a patient with STEMI: a case report

Discussion on the causes of thrombolysis failure in a patient with STEMI: a case report

Spontaneous coronary artery dissection in women in the generative period: clinical characteristics, treatment, and outcome—a systematic review and meta-analysis

Cardiac Troponin Serum Concentration Measurement Is Useful Not Only in the Diagnosis of Acute Cardiovascular Events

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