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==Definition of Multivessel Disease==
{{Spontaneous coronary artery dissection}}


<div style="font-size: 80%;" align="center">
For AEGIS-II inclusion criteria #5, multivessel disease criteria can be met by findings on the cardiac catheterization for the index MI, a prior cardiac catheterization, or both:
 
* Index MI cardiac catheterization: 50% or greater stenosis of the left main or at least <b><u>2</u></b> coronary artery territories (LAD, LCX, RCA) (prior to any interventions performed)
<span style="font-size: 1.5em; font-weight: bold;">Algorithm for the Angiographic Diagnosis and Confirmation of Spontaneous Coronary Artery Dissection</span><ref name="pmid24227590">{{cite journal| author=Saw J| title=Coronary angiogram classification of spontaneous coronary artery dissection. | journal=Catheter Cardiovasc Interv | year= 2014 | volume= 84 | issue= 7 | pages= 1115-22 | pmid=24227590 | doi=10.1002/ccd.25293 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24227590}}</ref><BR><BR>
* Prior cardiac catheterization: 50% or greater stenosis of left main or at least <b><u>2</u></b> coronary artery territories (LAD, LCx, RCA) (prior to any interventions performed)
 
* Both: Index MI cardiac catheterization with 1 vessel with 50% or greater stenosis (prior to any interventions performed) <b><u>AND</u></b> prior PCI of at least 1 vessel different from index MI vessel
{{Familytree/start}}
* Prior multivessel CABG
{{Familytree | | | | | A01 | | | | | | | | |
A01=<div style="text-align: left; font-weight: bold; padding: 5px;">
<div class="mw-customtoggle-x1" style="cursor: pointer;>
Presence of features that raise suspicion for SCAD?<BR><span style="color: #0645AD;">(click for details)</span>
</div>
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x1" style="font-size: 10px;">
----
❑&nbsp;&nbsp;[[Myocardial infarction]] in young women (age ≤50)
 
❑&nbsp;&nbsp;Absence of traditional [[Cardiovascular disease#Risk factors|cardiovascular risk factors]]
 
❑&nbsp;&nbsp;Little or no evidence of [[coronary atherosclerosis]]
 
❑&nbsp;&nbsp;[[Peripartum|Peripartum state]]
 
❑&nbsp;&nbsp;History of [[fibromuscular dysplasia]]
 
❑&nbsp;&nbsp;History of [[connective tissue disorder]] or [[systemic inflammation]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Marfan's syndrome]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Ehlers-Danlos syndrome|Ehlers-Danlos syndrome Type 4]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Loeys-Dietz syndrome]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Cystic medial necrosis]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Systemic lupus erythematosus]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Crohn's disease]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Ulcerative colitis]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Polyarteritis nodosa]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Sarcoidosis]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Churg-Strauss syndrome]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Wegener's granulomatosis]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Rheumatoid arthritis]]
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;[[Giant cell arteritis]]
----
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{{Familytree | | | | | |!| | | | | | | | | | }}
{{Familytree | | | | | B01 | | | | | | | | |
B01=<div style="text-align: left; font-weight: bold; padding: 5px;">
Perform early coronary angiography
</div>}}
{{Familytree | | | | | |!| | | | | | | | | | }}
{{Familytree | | | | | C01 | | | | | | | | |
C01=<div style="text-align: left; font-weight: bold; padding: 5px;">
<div class="mw-customtoggle-x2" style="cursor: pointer;>
Presence of type 1 SCAD lesion characteristics?<BR><span style="color: #0645AD;">(click for details)</span>
</div>
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x2" style="font-size: 10px;">
----
❑&nbsp;&nbsp;Contrast staining of arterial wall
 
❑&nbsp;&nbsp;Multiple radiolucent lumens
 
❑&nbsp;&nbsp;Contrast hang-up or slow clearing from the lumen
----
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{{Familytree | |,|-|-|-|^|-|-|-|.| | | | | | }}
{{Familytree | D01 | | | | | | D02 | | | | |
D01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
D02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>
}}
{{Familytree | |!| | | | | | | |!| | | | | | }}
{{Familytree | E01 | | | | | | E02 | | | | |
E01=<div style="text-align: left; font-weight: bold; padding: 5px;">Type 1 SCAD most likely</div>|
E02=<div style="text-align: left; font-weight: bold; padding: 5px;">
<div class="mw-customtoggle-x3" style="cursor: pointer;>
Presence of type 2 SCAD lesion characteristics?<BR><span style="color: #0645AD;">(click for details)</span>
</div>
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x3" style="font-size: 10px;">
----
❑&nbsp;&nbsp;Diffuse lesion (typically >20–30 mm)
❑&nbsp;&nbsp;Smooth luminal narrowing with varying severity
 
❑&nbsp;&nbsp;Involvement of mid to distal segments
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</div>
</div>
}}
{{Familytree | | | | | |,|-|-|-|^|-|-|-|.| | }}
{{Familytree | | | | | F01 | | | | | | F02 |
F01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
F02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>
}}
{{Familytree | | | | | |!| | | | | | | |!| | }}
{{Familytree | | | | | G01 | | | | | | G02 |
G01=<div style="text-align: left; font-weight: bold; padding: 5px;">Stenosis relieved by intracoronary nitroglycerin?</div>|
G02=<div style="text-align: left; font-weight: bold; padding: 5px;">
<div class="mw-customtoggle-x4" style="cursor: pointer;>
Look for type 3 SCAD lesion characteristics<BR><span style="color: #0645AD;">(click for details)</span>
</div>
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x4" style="font-size: 10px;">
----
❑&nbsp;&nbsp;Focal or tubular stenosis (typically <20 mm)
   
   
❑&nbsp;&nbsp;Mimics atherosclerosis
Multivessel disease requires a 50% or greater stenosis in at least 2 of the 3 major epicardial artery territories (LAD, LCx, RCA) or the left main vessel. Branch vessel disease may qualify as part of the territory of that branch vessel (for example, a diagonal vessel is considered part of the LAD territory). For the purpose of this study, the ramus is considered part of the Left Circumflex artery territory. If a branch vessel is used as a qualifying vessel, that branch should be of large enough size to potentially undergo revascularization if clinically indicated, e.g. >2mm vessel size.
 
❑&nbsp;&nbsp;Additional features
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;No atherosclerosis in other arteries
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;Long lesions (11–20 mm)
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;Hazy stenosis
 
&nbsp;&nbsp;&nbsp;&nbsp;❑&nbsp;&nbsp;Linear stenosis
----
</div>
</div>
}}
{{Familytree | |,|-|-|-|^|-|-|-|.| | | |!| | }}
{{Familytree | H01 | | | | | | H02 | | H03 |
H01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
H02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>|
H03=<div style="text-align: left; font-weight: bold; padding: 5px;">
Type 3 SCAD most likely
 
❑&nbsp;&nbsp;Consider OCT or IVUS for definitive diagnosis
 
❑&nbsp;&nbsp;Reassess with angiography in 4 to 6 weeks
</div>
}}
{{Familytree | |!| | | | | | | |!| | | | | | }}
{{Familytree | I01 | | | | | | I02 | | | | |
I01=<div style="text-align: left; font-weight: bold; padding: 5px;">R/O coronary spasm or other conditions</div>|
I02=<div style="text-align: left; font-weight: bold; padding: 5px;">
Type 2 SCAD most likely
 
❑&nbsp;&nbsp;Consider OCT or IVUS for definitive diagnosis


❑&nbsp;&nbsp;Reassess with angiography in 4 to 6 weeks
==MVD Tool==
</div>}}
{{Family tree/end}}
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==References==
{|
{{reflist|2}}
{{#Widget:MVD5}}
|}

Latest revision as of 20:26, 15 June 2020

Definition of Multivessel Disease

For AEGIS-II inclusion criteria #5, multivessel disease criteria can be met by findings on the cardiac catheterization for the index MI, a prior cardiac catheterization, or both:

  • Index MI cardiac catheterization: 50% or greater stenosis of the left main or at least 2 coronary artery territories (LAD, LCX, RCA) (prior to any interventions performed)
  • Prior cardiac catheterization: 50% or greater stenosis of left main or at least 2 coronary artery territories (LAD, LCx, RCA) (prior to any interventions performed)
  • Both: Index MI cardiac catheterization with 1 vessel with 50% or greater stenosis (prior to any interventions performed) AND prior PCI of at least 1 vessel different from index MI vessel
  • Prior multivessel CABG

Multivessel disease requires a 50% or greater stenosis in at least 2 of the 3 major epicardial artery territories (LAD, LCx, RCA) or the left main vessel. Branch vessel disease may qualify as part of the territory of that branch vessel (for example, a diagonal vessel is considered part of the LAD territory). For the purpose of this study, the ramus is considered part of the Left Circumflex artery territory. If a branch vessel is used as a qualifying vessel, that branch should be of large enough size to potentially undergo revascularization if clinically indicated, e.g. >2mm vessel size.

MVD Tool

Multivessel Disease Tool
To determine if your patient meets the eligibility criteria for multivessel disease, please check all arteries/segments with 50% or greater stenosis on the cardiac catheterization for index MI and/or vessels that have received prior PCI (stent or balloon angioplasty).
Left Main Coronary Artery Left Main Artery
Left Anterior Descending Artery Proximal LAD
Middle LAD
Distal LAD
First Diagonal Artery
Second Diagonal Artery
Third Diagonal Artery
Circumflex Artery Proximal Cx
Middle Cx
Distal Cx
First Obtuse Marginal Artery
Second Obtuse Marginal Artery
Third Obtuse Marginal Artery
Left Posterior Descending Artery
Left Posterior Atrioventricular Artery
Left Posterolateral Artery
Ramus Intermedius Artery
Right Coronary Artery Proximal RCA
Middle RCA
Distal RCA
Right Posterior Descending Artery
Right Posterior Atrioventricular Artery
Right Posterolateral Artery
Prior Multivessel Coronary Artery Bypass Grafting
Interpretation: