Spontaneous coronary artery dissection: A single-center case series and literature review

Abreu, Glória; Braga, Carlos Galvão; Costa, João; Azevedo, Pedro; Marques, Jorge

doi:10.1016/j.repc.2017.07.019

Cited by 23 publications

(13 citation statements)

References 21 publications

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“…Overall, 1458 titles and abstracts were first identified; after exclusion according to pre-specified criteria, 16 observational studies were included in the present pooled analysis (Figure 1). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] No randomized clinical trial was found. A total of 444 patients were included.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, most registries only report on combined outcomes at last available follow-up, but individual outcomes within the first crucial year after SCAD are rarely described and are mostly limited to small case reports and series. 18,20,21 Likewise, long-term comparisons of clinical outcomes of conservative versus invasive treatment strategies for SCAD have been reported in individual studies and meta-analyses describing similar clinical outcomes and lower target vessel revascularizations in medically-managed patients compared to those undergoing revascularization. 6,30 Nevertheless, MACE incidence within the first year after SCAD according to treatment strategy is still unknown.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes during the first year following spontaneous coronary artery dissection: A systematic timeframe pooled analysis

Bocchino

Franchin

Angelini

et al. 2021

Cathet Cardio Intervent

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Objectives: We aimed to compare the incidence and timing of major adverse cardiovascular events (MACE) within the first year after spontaneous coronary artery dissection (SCAD) according to the management strategy: conservative versus invasive.Background: Treatment of SCAD remains controversial.Methods: A pooled analysis of studies providing separate individual clinical outcomes for conservative and invasive treatment strategies within 1 year after SCAD was performed. The primary outcome measure was MACE incidence within three predefined study periods after SCAD, namely "in-hospital", "discharge-to-6-months"and "6-to-12-months". MACE was defined as a composite of all-cause death, myocardial infarction, target vessel revascularization, heart failure and SCAD recurrence.Results: A total of 16 studies (444 patients) were included; 277 (62%) patients were treated conservatively and 167 (38%) invasively. Within 1-year follow-up, 39 (67%) MACE occurred during the in-hospital period compared to 10 (17%) in the "discharge-to-6 months" period and 9 (16%) in the "6-to-12-months" period (p < 0.0001 for the overall comparison). MACE incidence was also significantly different between the three study periods in the conservatively-treated group (23 [78%] vs. 7 [23%] vs. 0 [0%], respectively; p < 0.0001) and the invasively-treated group (12 [66%] vs. 3 [17%] vs. 3 [17%], respectively; p < 0.0001), although no significant difference was found regarding MACE incidence in the intra-period comparisons between conservative and invasive treatment strategies.Conclusions: This pooled analysis showed that most MACE following SCAD occurred during the in-hospital period compared to the following two semesters, regardless of the treatment strategy. No difference regarding MACE incidence was found between conservative and invasive strategies in each study period.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes during the first year following spontaneous coronary artery dissection: A systematic timeframe pooled analysis

Bocchino

Franchin

Angelini

et al. 2021

Cathet Cardio Intervent

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“…Table 1 provides an overview of the characteristics of the 34 included studies 2,4‐6,11‐40 . The mean duration of follow‐up was 33 ± 20 months.…”

Section: Resultsmentioning

confidence: 99%

Mortality in spontaneous coronary artery dissection: A systematic review and meta‐analysis

Adams

Hughes

et al. 2021

Cathet Cardio Intervent

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Objective The aim of this systematic review and meta‐analysis was to provide a comprehensive estimate for spontaneous coronary artery dissection (SCAD) related mortality, and explore factors associated with an increased risk of death. Background SCAD is an infrequent but increasingly recognized cause of acute coronary syndrome. Despite a growing body of evidence, there have been few detailed examinations of SCAD associated mortality. Methods We searched MEDLINE, EMBASE, Cochrane, Web of Science and Google Scholar databases through May 7, 2020. We included studies reporting mortality data, confirmed SCAD with coronary angiography and included ≥10 participants. We excluded non‐English studies, conference abstracts, review articles and duplicate datasets. Random‐effects meta‐analysis and meta‐regression were used to evaluate estimates and predictors of mortality. Results From an initial 1,131 articles, 34 studies with 2,817 patients were eligible for inclusion. The weighted mean age was 50 years, and 84% of participants were female. The pooled estimate for SCAD mortality was 1% (Proportion 0.01; 95% CI, 0.00–0.02). The mean duration of follow‐up was 33 months. Meta‐regression showed male sex was associated with 3.5‐fold increased odds of mortality (OR, 3.50; 95% CI, 1.22–10.03). In addition, smoking (current or previous) was associated with a 15‐fold increased risk of mortality (OR 15.32; 95% CI, 2.88–81.41). Conclusions This meta‐analysis has shown that SCAD is associated with favorable survival outcomes with an estimated mortality of 1% over a mean follow‐up period of 33 months. We also found male sex and smoking were associated with an increased risk of mortality.

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“…The true prevalence of SCAD remains unknown as this is still an underdiagnosed disease. In recently published studies, SCAD accounted for 0.3%-1.2% of all ACS cases [3,[14][15][16] (Table 1). This condition affects predominantly young and middle-aged women (more than 70% of cases reported in sev-eral studies) [5].…”

Section: Incidence Precipitating Risk Factors Comorbidities and Clinical Presentationmentioning

confidence: 95%

The diagnosis and management of spontaneous coronary artery dissection — expert opinion of the Association of Cardiovascular Interventions (ACVI) of Polish Cardiac Society

et al. 2021

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Spontaneous coronary artery dissection: A single-center case series and literature review

Abstract: In the studied population, SCAD was more prevalent in middle-aged women. Despite the high prevalence of in-hospital re-infarction or during follow-up, the prognosis was good overall.

Cited by 23 publications

References 21 publications

Outcomes during the first year following spontaneous coronary artery dissection: A systematic timeframe pooled analysis

Outcomes during the first year following spontaneous coronary artery dissection: A systematic timeframe pooled analysis

Mortality in spontaneous coronary artery dissection: A systematic review and meta‐analysis

The diagnosis and management of spontaneous coronary artery dissection — expert opinion of the Association of Cardiovascular Interventions (ACVI) of Polish Cardiac Society

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