Spontaneous Coronary Artery Dissection in Patients With Fibromuscular Dysplasia

Saw, Jacqueline; Poulter, Rohan; Fung, Anthony; Wood, David; Hamburger, J; Buller, Christopher E.

doi:10.1161/circinterventions.111.966630

Cited by 125 publications

(86 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is probably because all types of CD were included our analysis, whereas other studies have included mostly SCD which is more prevalent in younger women with FMD. Our population also had a very low number of patients with FMD, which occurs more commonly in women with SCD [14]. Women had a higher mortality rate (5.5%) than males (3.2%), something that has been not been described before in a CD population.…”

Section: Discussionmentioning

confidence: 76%

“…This once again may be explained by the inclusion of all types of CD including atherosclerotic and iatrogenic, which may be associated with lower mortality in general and also be more likely to include patients treated with statins. Treatment with statins may be protective and may be used more frequently in patients with non-SCD since statins are known to reduce peri-procedural myocardial infarction [15], diminish the inflammatory response [13,14,16] and are used for primary [16,17] and secondary prevention [18,19] of cardiovascular death [20,21]. Future studies may determine their role in all comers with CD.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of in-hospital mortality in coronary artery dissection: Findings from the National Inpatient Sample 2009–2010

et al. 2015

View full text Add to dashboard Cite

(OR 5.86, p < 0.001) predicted higher mortality, while hyperlipidemia (OR 0.26, p < 0.001) and CAD (OR 0.31, p = 0.001) predicted lower mortality in multivariate analysis. Conclusions: Our study demonstrated that CD was more prevalent in men but women had higher mortality than men. Age, heart failure and ventricular arrhythmias were independent predictors of increased mortality but hyperlipidemia CAD predicted lower mortality in patients with CD. (Cardiol J 2015; 22, 2: 135-140)

show abstract

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Predictors of in-hospital mortality in coronary artery dissection: Findings from the National Inpatient Sample 2009–2010

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Fibromuscular dysplasia (FMD) is an inflammatory non-atherosclerotic vascular disease strongly associated with SCAD and should be always investigated [13][14][15][16]. Pregnancy is also considered a condition predisposing to SCAD; this association may be due to the drastic hemodynamic changes and the increase of several hormone levels [17,18].…”

Section: Pathogenesismentioning

confidence: 99%

How to Approach a Spontaneous Coronary Artery Dissection: An Up-To-Date

Pepe¹,

Cecere²,

Napodano³

et al. 2017

Interv Cardiol J

View full text Add to dashboard Cite

AbstarctSpontaneous coronary artery dissection (SCAD) is a separation of the coronary wall layers, not related to trauma, medical procedures or atherosclerosis. The dissection causes the blood entry in the vascular wall with the consequent formation of a false lumen and intramural hematoma (IMH). Two pathogenetic mechanisms have been proposed to explain SCAD: a "primary" rupture of coronary endothelium or the rupture of the "vasa vasorum". Clinical presentation and severity of manifestations are variable, ranging from complete absence of symptoms to acute coronary syndrome (ACS), cardiogenic shock, cardiac arrest or sudden cardiac death. Despite coronary angiography is the first-line examination, by supplying two-dimensional images of the lumen, it does not always allow an incontrovertible diagnosis of SCAD. New intravascular imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS), have been recently introduced and may be extremely helpful in assessing the coronary wall integrity, thus improving coronary angiography diagnostic accuracy.Because of the lack of large randomized trials comparing different strategies, the optimal treatment of SCAD is still controversial. The first-line approach is conservative and based on medical therapy. Nevertheless, in particular situations an invasive approach is necessary. In the last years, several new strategies have improved the way to perform percutaneous coronary interventions (PCI), such as new generation drug eluting stents (DES), bio-resorbable scaffolds (BRS), sirolimus self-expandable stent (SES), drug eluting balloons (DEB), and cutting balloon. Cardiac artery bypass graft (CABG) is an even more invasive method to restore coronary flow and should be considered in urgent/emergent settings when PCI is not feasible or has failed.Cause the therapeutic approach of SCAD can be substantially different from that of atherosclerotic coronary artery disease, an accurate diagnosis is crucial to set up the best treatment strategy.

show abstract

“…Female gender, absence of atherosclerotic risk factors, presence of unique angiographic signs, characteristic findings on intravascular ultrasound (IVUS) or optical coherence tomography (OCT) [4], and presence of concomitant fibromuscular dysplasia (FMD) in non-coronary vascular beds [5][6][7] may help establish the diagnosis. Traditionally, the diagnosis of SCAD is made by coronary angiography and/or intravascular imaging [1].…”

Section: Editorialmentioning

confidence: 99%