Mackram F Eleid1, Raviteja R Guddeti1, Marysia S Tweet1, Amir Lerman1, Mandeep Singh1, Patricia J Best1, Terri J Vrtiska1, Megha Prasad1, Charanjit S Rihal1, Sharonne N Hayes1, Rajiv Gulati2. 1. From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN. 2. From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN. Gulati.rajiv@mayo.edu.
Abstract
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized nonatherosclerotic cause of acute coronary syndrome. The angiographic characteristics of SCAD are largely undetermined. The goal of this study was to determine the prevalence of coronary tortuosity in SCAD and whether it may be implicated in the disease. METHODS AND RESULTS: Patients with confirmed SCAD (n=246; 45.3±8.9 years; 96% women) and 313 control patients without SCAD or coronary artery disease who underwent coronary angiography were included in this case-control study. Angiograms were reviewed for coronary tortuosity and assigned a tortuosity score. Tortuosity was common in patients presenting with their first SCAD event (78% versus 17% in controls; P<0.0001; tortuosity score, 4.41±1.73 versus 2.33±1.49 in controls; P<0.0001) despite a low prevalence of hypertension (34%). Recurrent SCAD (n=40) occurred within segments of tortuosity in 80% of cases. Severe tortuosity (≥2 consecutive curvatures ≥180°) was associated with a higher risk of recurrent SCAD (hazard ratio, 3.29; 95% confidence interval, 0.99-8.29; P=0.05). Tortuosity score >5 was associated with a trend toward higher risk of recurrent SCAD (P=0.16). Prespecified angiographic markers of tortuosity including corkscrew appearance and multivessel symmetrical tortuosity were associated with extracoronary vasculopathy including fibromuscular dysplasia (P<0.05 for both). CONCLUSIONS: Coronary artery tortuosity is highly prevalent in the SCAD population and is associated with recurrent SCAD. Recurrent SCAD most often occurs within segments of tortuosity. Angiographic features of SCAD are associated with extracoronary vasculopathy, including fibromuscular dysplasia. These findings suggest that coronary tortuosity may serve as a marker or potential mechanism for SCAD.
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized nonatherosclerotic cause of acute coronary syndrome. The angiographic characteristics of SCAD are largely undetermined. The goal of this study was to determine the prevalence of coronary tortuosity in SCAD and whether it may be implicated in the disease. METHODS AND RESULTS:Patients with confirmed SCAD (n=246; 45.3±8.9 years; 96% women) and 313 control patients without SCAD or coronary artery disease who underwent coronary angiography were included in this case-control study. Angiograms were reviewed for coronary tortuosity and assigned a tortuosity score. Tortuosity was common in patients presenting with their first SCAD event (78% versus 17% in controls; P<0.0001; tortuosity score, 4.41±1.73 versus 2.33±1.49 in controls; P<0.0001) despite a low prevalence of hypertension (34%). Recurrent SCAD (n=40) occurred within segments of tortuosity in 80% of cases. Severe tortuosity (≥2 consecutive curvatures ≥180°) was associated with a higher risk of recurrent SCAD (hazard ratio, 3.29; 95% confidence interval, 0.99-8.29; P=0.05). Tortuosity score >5 was associated with a trend toward higher risk of recurrent SCAD (P=0.16). Prespecified angiographic markers of tortuosity including corkscrew appearance and multivessel symmetrical tortuosity were associated with extracoronary vasculopathy including fibromuscular dysplasia (P<0.05 for both). CONCLUSIONS: Coronary artery tortuosity is highly prevalent in the SCAD population and is associated with recurrent SCAD. Recurrent SCAD most often occurs within segments of tortuosity. Angiographic features of SCAD are associated with extracoronary vasculopathy, including fibromuscular dysplasia. These findings suggest that coronary tortuosity may serve as a marker or potential mechanism for SCAD.
Authors: Fernando Alfonso; Teresa Bastante; Javier Cuesta; Daniel Rodríguez; Amparo Benedicto; Fernando Rivero Journal: Cardiovasc Diagn Ther Date: 2015-04
Authors: Fernando Alfonso; Marcos García-Guimaraes; Teresa Bastante; Francisco de la Cuerda; Paula Antuña; Javier Cuesta; Fernando Rivero Journal: J Thorac Dis Date: 2018-07 Impact factor: 2.895
Authors: Tamiel N Turley; Jeanne L Theis; Rhianna S Sundsbak; Jared M Evans; Megan M O'Byrne; Rajiv Gulati; Marysia S Tweet; Sharonne N Hayes; Timothy M Olson Journal: Circ Genom Precis Med Date: 2019-03-19