Treatment strategy for spontaneous coronary artery dissection based on anatomical characteristics

Ma, Yuanji; Zhong, Xin; Yin, Jun; Lu, Hao; Pan, Congcong; Huang, Dong; Ge, Junbo

doi:10.1186/s40001-023-00986-y

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…CABG was performed after PCI failure. Ma et al ( 23 ) divided SCAD patients into high or low risk based on the lesion location and intramural hematoma. LM or proximal coronary artery segment involvement was categorized as high risk.…”

Section: Resultsmentioning

confidence: 99%

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Management and outcomes of spontaneous coronary artery dissection: a systematic review of the literature

Petrović,

Miljković,

Ilić

et al. 2024

Front. Cardiovasc. Med.

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BackgroundContemporary management of spontaneous coronary artery dissection (SCAD) is still controversial. This systematic review of the literature aims to explore outcomes in the patients treated with conservative management vs. invasive strategy.MethodsThe PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed when we extensively searched three electronic databases: PubMed, ScienceDirect, and Web of Science, for studies that compared conservative vs. invasive revascularization treatment outcomes for patients with SCAD from 2003 to 2023. The outcomes of interest were all-cause death and major adverse cardiovascular events (MACE), including acute coronary syndrome (ACS), heart failure (HF), need for additional revascularization, target vessel revascularization (TVR), SCAD recurrence, and stroke.ResultsThe systematic review included 13 observational studies evaluating 1,801 patients with SCAD. The overall mean age was 49.12 +/− 3.41, and 88% were females. The overall prevalence of arterial hypertension was 33.2%, hyperlipidemia, 26.9%, smoking, 17.8%, and diabetes, 3.9%. Approximately 48.5% of the patients were diagnosed with non-ST elevated myocardial infarction (NSTEMI), 36.8% with ST elevated myocardial infarction (STEMI), 3.41% with unstable angina, 0.56% with stable angina, and 0.11% were diagnosed with various types of arrhythmias. The left anterior descending artery (LAD) was the most common culprit lesion in 51% of the patients. There were initially 65.2% of conservatively treated patients vs. 33.4% that underwent percutaneous coronary intervention (PCI) or 1.28% that underwent coronary artery bypass graft (CABG). SCAD-PCI revascularization was associated with a variable range of PCI failure. The most common complications were hematoma extension and iatrogenic dissection. SCAD-PCI revascularization frequently required three or more stents and had residual areas of dissection. The overall reported in-hospital and follow-up mortality rates were 1.2% and 1.3%, respectively. The follow-up range across studies was 7.3–75.6 months. The authors reported variable prevalence of MACE, recurrent SCAD up to 31%, ACS up to 27.4%, TVR up to 30%, repeat revascularization up to 14.7%, UA up to 13.3%, HF up to 17.4%, and stroke up to 3%.ConclusionOur results highlight that conservative treatment should be the preferred method of treatment in patients with SCAD. PCI revascularization is associated with a high prevalence of periprocedural complications. SCAD poses a considerable risk of MACE, mainly associated with TVR, ACS, and recurrent SCAD.

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Section: Resultsmentioning

confidence: 99%

“…The general conclusion in the majority of included studies is that conservative treatment should be the preferred method of treatment. In studies that did report follow-up angiographies, a high prevalence of vessel healing in bout groups was observed ( 23 ).…”

Section: Resultsmentioning

confidence: 99%

Management and outcomes of spontaneous coronary artery dissection: a systematic review of the literature

Petrović,

Miljković,

Ilić

et al. 2024

Front. Cardiovasc. Med.

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Interventional treatment of non-spontaneously healed spontaneous coronary artery dissection: a case report

Ying,

Chen,

Tang

et al. 2024

BMC Cardiovasc Disord

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Background Spontaneous coronary artery dissection (SCAD) is a significant cause of non-atherosclerotic acute coronary syndrome, myocardial infarction, and sudden cardiac death. Women account for 87–95% of SCAD patients, with the average age of onset ranging from 44 to 53 years. Approximately 95% of cases reported to resolve spontaneously. However, percutaneous coronary intervention (PCI) can lead to various complications, prompting guidelines to recommend conservative management for patients categorized as low-risk. Case presentation A 49-year-old woman presented with intermittent dyspnea lasting three months. Initial coronary angiography revealed severe stenosis of the left anterior descending artery (LAD). Intravascular ultrasound (IVUS) demonstrated dissection, hematoma, and thrombus in the proximal LAD. Following balloon dilation, the hematoma extended distally, resulting in no-reflow, which subsequently led to thrombosis in the left main coronary artery. A stent was deployed from the mid to proximal LAD, leading to gradual improvement in blood flow, achieving TIMI grade 3. Two months post-discharge, the patient was readmitted. Coronary angiography showed patent stents, with no significant stenosis in the previously placed stent, but a new stent was inserted in the distal segment of the LAD. Eight months later, repeat angiography revealed patent stents and no notable abnormalities in the remaining vessels. Conclusion For high-risk SCAD patients who do not exhibit spontaneous healing, vascular revascularization should be considered judiciously. Clinical trial number Not applicable. Graphical abstract

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In-hospital and long-term clinical outcomes of spontaneous coronary artery dissection (SCAD): a meta-analysis of conservative versus revascularization approaches

Pitliya,

Vasudevan

et al. 2024

Egypt Heart J

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Background The ideal treatment strategy for spontaneous coronary artery dissection (SCAD) remains unclear, with patients potentially treated with either conservative medical care or a revascularization approach. Methods We performed a systematic review and meta-analysis adhering to PRISMA 2020 guidelines. Inclusion criteria involved studies with confirmed SCAD diagnosis, reporting initial management strategies, and original research with ≥ 10 participants. Random-effect models were applied for insignificant heterogeneity with significance at p ≤ 0.05. Sensitivity analysis and funnel plots assessed potential publication bias. Results Our analysis found no significant differences in major adverse cardiac events (MACE) (OR = 0.61, p = 0.49), unstable angina pectoris (UAP) (OR = 1.04, p = 0.93), non-ST segment elevation myocardial infarction (NSTEMI) (OR = 1.16, p = 0.82), recurrent myocardial infarction (MI) (OR = 0.78, p = 0.56), stroke (OR = 0.35, p = 0.07), heart failure (OR = 0.41, p = 0.24), in-hospital mortality (OR = 0.35, p = 0.09), post-discharge mortality (OR = 1.66, p = 0.27), or ST segment elevation myocardial infarction (STEMI) (OR = 0.45, p = 0.23) between conservative management and revascularization procedures. However, sensitivity analysis reveals significant decreases in odds of inferior wall STEMI (OR = 0.41 [95% CI 0.17–0.97], p = 0.04) and heart failure (OR = 0.18 [95% CI 0.06–0.54], p = 0.002) in conservative treatment compared to revascularization group. Conclusion Conservative therapy significantly decreased inferior wall STEMI and heart failure as compared to revascularization in SCAD. Although no significant differences in cardiovascular outcomes, sensitivity analysis highlights potential benefits of conservative management.

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Treatment strategy for spontaneous coronary artery dissection based on anatomical characteristics

Cited by 3 publications

References 22 publications

Management and outcomes of spontaneous coronary artery dissection: a systematic review of the literature

Management and outcomes of spontaneous coronary artery dissection: a systematic review of the literature

Interventional treatment of non-spontaneously healed spontaneous coronary artery dissection: a case report

In-hospital and long-term clinical outcomes of spontaneous coronary artery dissection (SCAD): a meta-analysis of conservative versus revascularization approaches

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