Spontaneous Coronary Artery Dissection in the Gulf: G-SCAD Registry

Abstract

Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events ( P = .029).

Spontaneous Coronary Artery Dissection with Sudden Cardiac Arrest in a Female Patient During Her Postpartum Period: A Case Report and Review

“…In addition, fibromuscular dysplasia (FMD) was also linked to SCAD in multiple reports [ 19 , 22 , 23 ]. This was not the case according to a recently published local registry in our area, the Arab Gulf countries SCAD registry (G-SCAD registry), which showed that not a single patient reported a history of FMD or inflammatory diseases [ 12 ]. There is limited literature on the etiology of SCAD and its natural history, especially in our area, the Middle East.…”

“…In contrast, another paper from the same author showed that almost all patients had a predisposing arterial disease [ 16 ]. Pregnancy and the postpartum period were associated with many SCAD cases [ 2 , 6 , 12 , 17 ]. An analysis of 120 pregnancy-associated SCAD cases over 15 years showed that pregnancy-associated SCAD is associated with a high incidence of reduced ejection fraction and life-threating maternal and fetal complications [ 18 ].…”

Pregnancy-Related Spontaneous Coronary Artery Pseudoaneurysm Healed by Medical Treatment Guided by Optical Coherence Tomography

“…[ 3 4 ] Although the pathophysiology and etiology are unknown, hormonal changes during pregnancy may be the reason for structural changes in the vessel wall, including loss of elastic fibers and a decrease in acid mucopolysaccharides. [ 5 ] Other factors, such as hemodynamic stress and changes in the autoimmune status, have also been considered as possible etiological factors. [ 5 ]…”

“…[ 5 ] Other factors, such as hemodynamic stress and changes in the autoimmune status, have also been considered as possible etiological factors. [ 5 ]…”

Diseksi Spontan Arteri Koroner: Diagnosis dan Manajemen

“…Insidensi terjadi SCAD sebagai penyebab SKA relatif kecil diantara 1-4% dari kasus SKA [5], [6]. Adapun penelitiaan dengan populasi banyak juga menemukan hanya 0.04% atau kurang dari 1% [7]. Namun penelitian menunjukkan peningkatan insidensi dan penyumbang terbesar kasus pada perempuan [5], [8], Selain itu, SCAD memiliki karakteristik usia muda dan memiliki faktor risiko aterosklerosis yang rendah [2], [3].…”