Prospektive Untersuchung zu Häufigkeit, Pathogenese und Therapie spontaner, koronarangiographisch diagnostizierter Koronararteriendissektionen

Abstract

Spontaneous coronary artery dissection is a rare cause of ischemic heart disease. Incidence, etiology and optimal treatment are ill-defined. Between July 1995 and December 1997, we prospectively identified 42 patients (36 men, six women, mean age 59 +/- 12 years) with spontaneous coronary artery dissection among 3803 consecutive angiographic examinations in which the diagnosis of coronary artery disease was established for the first time (incidence 1.1%). In comparison to the remaining study population with stable angina pectoris (8 cases of spontaneous coronary artery dissection among 2852 patients; incidence: 0.3%), the incidence of spontaneous coronary artery dissection was significantly higher in the patient subgroups with acute myocardial infarction (13/450; 2.9%) and with unstable angina pectoris or postinfarction angina (21/501; 4.2%). Dissection was most frequently located in the left anterior descending coronary artery (19 cases), followed by the right coronary artery (15 cases) and the left circumflex coronary artery (8 cases). Because of an ambiguous angiographic lesion appearance intravascular ultrasound imaging was performed in 13 patients to confirm the diagnosis. The presumed etiology of spontaneous coronary artery dissection was atherosclerotic plaque rupture in 35 cases, heavy physical exercise in four cases and hormonal influences related to pregnancy and contraception in one case. In two cases, no obvious risk factor could be identified. Therapy consisted of intracoronary stenting in 24 patients (including ten patients with acute myocardial infarction), coronary artery bypass grafting (CABG) in 8 patients and balloon angioplasty (PTCA) in seven patients. Three patients were treated conservatively. During a mean follow-up period of 13.5 +/- 9.9 months, two patients died and 31 patients remained entirely asymptomatic, including all patients who were treated with CABG. Restenosis developed in three patients after stent implantation (restenosis rate: 12.5%). Following primary PTCA, spontaneous coronary artery dissection recurred in two patients, one of whom subsequently died.

A case of spontaneous coronary artery dissection presenting with acute anterior wall myocardial infarction in a young adult male – an increasingly recognized rare disease

“…Regarding management, it remains highly controversial especially in regards to the value of coronary revascularization over a conservative medical management [12,13]. Conservative management is preferred in stable patients with SCAD as most dissected segments will heal spontaneously [9].…”

Conservative Treatment of Spontaneous Dissection of Multiple Coronary Arteries

“…It has been described in the context of recent exertion [2,5], hypertension [4,10], taking oral contraceptives [9] and recreational use of cocaine [14]. Involvement of multiple coronary arteries [1,4,6] has been described.…”

“…A number of patients have been treated with coronary artery bypass grafting [1,2,7,8,14,16] although fashioning a distal anastomosis may be difficult [1].…”

Dissecção espontânea de artéria coronária causando síndrome coronariana aguda

“…Assumed etiology includes: Disruption of atherosclerotic plaque, exhausting physical exercise, pregnancy related hormonal infl uence, use of contraceptives; in some cases, risk factors cannot be identifi ed. 4 Treatment consists of: clinical and drug treatment, myocardial revascularization surgery, angioplasty with stent, and at times even heart transplant. 5 As for the case in question, we have presented the use of a combination: drug therapy + stent.…”