Marcos García-Guimaraes1, Teresa Bastante1, Fernando Macaya2, Gerard Roura3, Ricardo Sanz4, Jean Christophe Barahona Alvarado5, Helena Tizón6, Xacobe Flores-Ríos7, José Moreu8, Soledad Ojeda9, Juan Manuel Nogales10, Gabriela Veiga11, Mónica Masotti12, Santiago Jesús Camacho-Freire13, Santiago Jiménez-Valero14, Marcelo Jiménez-Kockar15, Íñigo Lozano16, Rocío González-Ferreiro17, Maite Velázquez18, Pablo Avanzas19, Fernando Rivero1, Fernando Alfonso20. 1. Servicio de Cardiología, Hospital Universitario de La Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. 2. Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain. 3. Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 4. Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. 5. Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain. 6. Servicio de Cardiología, Hospital del Mar, Barcelona, Spain. 7. Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain. 8. Servicio de Cardiología, Complejo Hospitalario de Toledo, Toledo, Spain. 9. Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain. 10. Servicio de Cardiología, Hospital Universitario de Badajoz, Badajoz, Spain. 11. Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain. 12. Servicio de Cardiología, Hospital Clínic de Barcelona, Barcelona, Spain. 13. Servicio de Cardiología, Hospital Juan Ramón Jiménez, Huelva, Spain. 14. Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain. 15. Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 16. Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain. 17. Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain. 18. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain. 19. Servicio de Cardiología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Oviedo, Asturias, Spain. 20. Servicio de Cardiología, Hospital Universitario de La Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. Electronic address: falf@hotmail.com.
Abstract
INTRODUCTION AND OBJECTIVES: Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome. The characteristics and in-hospital clinical course of patients with SCAD in Spain remain unknown. METHODS: We present data from consecutive patients included in the national prospective SCAD registry. Angiographic analysis was performed in a centralized core laboratory. RESULTS: Between June 2015 and April 2019, we included 318 patients with SCAD (358 lesions) from 31 centers. Median age was 53 years, and 88% were women. The most frequent presentation was non-ST-segment elevation acute myocardial infarction (53%). The most frequently involved artery was the left anterior descending coronary artery (44%), predominantly affecting the distal segments (39%) and secondary branches (54%). Most lesions (62%) appeared on angiography as intramural hematoma, without double lumen. Conservative management was selected as the initial approach in most patients (78%). During the index admission, 6% of patients had a major adverse event and 4 patients (1.3%) died. Independent predictors of adverse events were initial management with percutaneous coronary intervention (OR, 5.97; P=.004) and angiographic presentation as intramural hematoma (OR, 4.96; P=.028). CONCLUSIONS: In Spain, SCAD affects mainly middle-aged women. In most patients, the initial management strategy was conservative with excellent in-hospital survival. Initial management with percutaneous coronary intervention and angiographic presentation as intramural hematoma were related to the presence of in-hospital adverse events. Registered at ClnicalTrials.gov (Identifier: NCT03607981).
INTRODUCTION AND OBJECTIVES: Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome. The characteristics and in-hospital clinical course of patients with SCAD in Spain remain unknown. METHODS: We present data from consecutive patients included in the national prospective SCAD registry. Angiographic analysis was performed in a centralized core laboratory. RESULTS: Between June 2015 and April 2019, we included 318 patients with SCAD (358 lesions) from 31 centers. Median age was 53 years, and 88% were women. The most frequent presentation was non-ST-segment elevation acute myocardial infarction (53%). The most frequently involved artery was the left anterior descending coronary artery (44%), predominantly affecting the distal segments (39%) and secondary branches (54%). Most lesions (62%) appeared on angiography as intramural hematoma, without double lumen. Conservative management was selected as the initial approach in most patients (78%). During the index admission, 6% of patients had a major adverse event and 4 patients (1.3%) died. Independent predictors of adverse events were initial management with percutaneous coronary intervention (OR, 5.97; P=.004) and angiographic presentation as intramural hematoma (OR, 4.96; P=.028). CONCLUSIONS: In Spain, SCAD affects mainly middle-aged women. In most patients, the initial management strategy was conservative with excellent in-hospital survival. Initial management with percutaneous coronary intervention and angiographic presentation as intramural hematoma were related to the presence of in-hospital adverse events. Registered at ClnicalTrials.gov (Identifier: NCT03607981).
Authors: Henrik Wilander; Christos Pagonis; Dimitrios Venetsanos; Eva Swahn; Christian Dworeck; Nina Johnston; Lena Jonasson; Thomas Kellerth; Per Tornvall; Troels Yndigegn; Sofia Sederholm Lawesson Journal: BMJ Open Date: 2022-06-01 Impact factor: 3.006