Spontaneous coronary artery dissection: an Italian single centre experience

Abstract

Aims Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute myocardial infarction (AMI) in young women without a typical cardiovascular risk profile. Knowledge on SCAD is based on observational studies and is still scarce. The aim of this monocentric observational study was to evaluate the predisposing factors, clinical features and prognosis of SCAD patients.Methods Between 2013 and 2020, 58 patients with angiographic diagnosis of SCAD were identified in our centre with an overall prevalence of 0.9% among patients admitted for AMI (58 of 6414 patients). ResultsThe mean age was 54W 11 years and the majority were women (n U 50, 86%) with one or fewer cardiovascular risk factors (n U 35, 60%). The prevalence of Fibromuscolar Dysplasia (FMD) was 39% (7 of 18 screened patients). The rate of major adverse cardiovascular and cerebrovascular events (MACCEs) was used to assess the prognosis. Out-of-hospital cardiac arrest because of ventricular fibrillationo was observed in four (7%) patients. The majority of patients (n U 51, 88%) were treated conservatively without revascularization. The inhospital and 30-day clinical course was uneventful in most patients (n U 54, 93%) with two cardiac deaths. During a median follow-up of 12 months, there were no further deaths. The global rate of SCAD recurrence was significant (n U 8, 14%) but predictors have not been identified. ConclusionAlthough overall survival seems good, SCAD is a potentially malignant, not rare disease, which can present with sudden cardiac death and not uncommon recurrence. Prognostic stratification and optimal management of SCAD patients remain to be defined.

Spontaneous Coronary Artery Dissection in Clinical Practice: Pathophysiology and Therapeutic Approaches

“…SCAD is an interesting pathophysiological example of MINOCA, which remains often underdiagnosed. Despite a good overall survival rate, this condition seems common and potentially malignant because of recurrences and the possibility that it might cause several complications, such as sudden cardiac death and cardiogenic shock [84]. Randomized trials are awaited to fill the current gaps in SCAD treatment approach.…”

Diseksi Spontan Arteri Koroner: Diagnosis dan Manajemen

“…Konsesus merekomendasikan manajemen konservatif diutamakan dibandingkan invasif pada SCAD [30]. Pasien yang dilakukan penanganan konservatif memiliki tingkat bertahan hidup yang baik [10], [23]. Ada beberapa penilaian yang menentukan penanganan konservatif lebih menguntung yaitu pada pembuluh darah distal dan basal thrombolysis in Myocardial Infarction (TIMI) grade 2/3 [31].…”

Sex matters: the frequently overlooked importance of considering sex in computational models

“…Under ischaemic stress, females have been found to exhibit better resilience to oxygen deprivation than males owing to the cardioprotective effect of oestrogen in restoring mitochondrial activity and reducing apoptosis, thereby minimising infarct size ( Dunlay and Roger, 2012 ; Wang et al, 2019 ). In addition spontaneous coronary artery dissection, a nonatherosclerotic aetiology of acute myocardial infarction, and Taktsubo stress cardiomyopathy are more common in women ( Templin et al, 2015 ; Solinas et al, 2022 ).…”