Spontaneous coronary artery dissection natural history, complications and prognosis: Difference between revisions
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===Natural History=== | ===Natural History=== | ||
The natural history of spontaneous coronary artery dissection (SCAD) has not been well characterized. Early reports based on [[autopsy|post-mortem examinations]] after [[sudden cardiac death]] suggest a high mortality rate with SCAD.<ref name="AlfonsoBastante2014">{{cite journal|last1=Alfonso|first1=Fernando|last2=Bastante|first2=Teresa|last3=Rivero|first3=Fernando|last4=Cuesta|first4=Javier|last5=Benedicto|first5=Amparo|last6=Saw|first6=Jacqueline|last7=Gulati|first7=Rajiv|title=Spontaneous Coronary Artery Dissection|journal=Circulation Journal|volume=78|issue=9|year=2014|pages=2099–2110|issn=1346-9843|doi=10.1253/circj.CJ-14-0773}}</ref> In contrast, data from recent case series indicate that the majority of SCAD lesions heal spontaneously over time and achieve complete resolution on repeat angiography by 26 days among patients who survived initial hospitalization.<ref name="SawAymong2014">{{cite journal|last1=Saw|first1=J.|last2=Aymong|first2=E.|last3=Sedlak|first3=T.|last4=Buller|first4=C. E.|last5=Starovoytov|first5=A.|last6=Ricci|first6=D.|last7=Robinson|first7=S.|last8=Vuurmans|first8=T.|last9=Gao|first9=M.|last10=Humphries|first10=K.|last11=Mancini|first11=G. B. J.|title=Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes|journal=Circulation: Cardiovascular Interventions|volume=7|issue=5|year=2014|pages=645–655|issn=1941-7640|doi=10.1161/CIRCINTERVENTIONS.114.001760}}</ref><ref name="RogowskiMaeder2017">{{cite journal|last1=Rogowski|first1=Sebastian|last2=Maeder|first2=Micha T.|last3=Weilenmann|first3=Daniel|last4=Haager|first4=Philipp K.|last5=Ammann|first5=Peter|last6=Rohner|first6=Franziska|last7=Joerg|first7=Lucas|last8=Rickli|first8=Hans|title=Spontaneous Coronary Artery Dissection|journal=Catheterization and Cardiovascular Interventions|volume=89|issue=1|year=2017|pages=59–68|issn=15221946|doi=10.1002/ccd.26383}}</ref> | |||
The fact that the diagnosis was made so often in the past on autopsy speaks to the poor clinical outcomes that have been associated with the condition. Outcomes in the modern era of [[stent]] placement and improved [[antithrombin]]s may be improved, but solid data are lacking. Based on the limited outcomes data, SCAD survivors typically have a good long-term prognosis. Majority of cases result in spontaneous healing, with improvement starting after several weeks and resolution at approximately 1-2 years.<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> However, there is an increased risk for recurrent SCAD events as well as other major cardiovascular events.<ref name="Tweet-2012">{{Cite journal | last1 = Tweet | first1 = MS. | last2 = Hayes | first2 = SN. | last3 = Pitta | first3 = SR. | last4 = Simari | first4 = RD. | last5 = Lerman | first5 = A. | last6 = Lennon | first6 = RJ. | last7 = Gersh | first7 = BJ. | last8 = Khambatta | first8 = S. | last9 = Best | first9 = PJ. | title = Clinical features, management, and prognosis of spontaneous coronary artery dissection. | journal = Circulation | volume = 126 | issue = 5 | pages = 579-88 | month = Jul | year = 2012 | doi = 10.1161/CIRCULATIONAHA.112.105718 | PMID = 22800851 }}</ref> | The fact that the diagnosis was made so often in the past on autopsy speaks to the poor clinical outcomes that have been associated with the condition. Outcomes in the modern era of [[stent]] placement and improved [[antithrombin]]s may be improved, but solid data are lacking. Based on the limited outcomes data, SCAD survivors typically have a good long-term prognosis. Majority of cases result in spontaneous healing, with improvement starting after several weeks and resolution at approximately 1-2 years.<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> However, there is an increased risk for recurrent SCAD events as well as other major cardiovascular events.<ref name="Tweet-2012">{{Cite journal | last1 = Tweet | first1 = MS. | last2 = Hayes | first2 = SN. | last3 = Pitta | first3 = SR. | last4 = Simari | first4 = RD. | last5 = Lerman | first5 = A. | last6 = Lennon | first6 = RJ. | last7 = Gersh | first7 = BJ. | last8 = Khambatta | first8 = S. | last9 = Best | first9 = PJ. | title = Clinical features, management, and prognosis of spontaneous coronary artery dissection. | journal = Circulation | volume = 126 | issue = 5 | pages = 579-88 | month = Jul | year = 2012 | doi = 10.1161/CIRCULATIONAHA.112.105718 | PMID = 22800851 }}</ref> | ||
Revision as of 21:10, 4 December 2017
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Spontaneous Coronary Artery Dissection Microchapters |
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Differentiating Spontaneous coronary artery dissection from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Type 1 Type 2A Type 2B Type 3 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.
Synonyms and keywords: SCAD
Overview
The natural history of spontaneous coronary artery dissection has not been well characterized. Early reports based on post-mortem examinations after sudden cardiac death suggest a dismal prognosis. However, recent studies demonstrate that most patients survive initial hospitalization and have a favorable prognosis following clinical stabilization.
Natural History, Complications and Prognosis
Natural History
The natural history of spontaneous coronary artery dissection (SCAD) has not been well characterized. Early reports based on post-mortem examinations after sudden cardiac death suggest a high mortality rate with SCAD.[1] In contrast, data from recent case series indicate that the majority of SCAD lesions heal spontaneously over time and achieve complete resolution on repeat angiography by 26 days among patients who survived initial hospitalization.[2][3]
The fact that the diagnosis was made so often in the past on autopsy speaks to the poor clinical outcomes that have been associated with the condition. Outcomes in the modern era of stent placement and improved antithrombins may be improved, but solid data are lacking. Based on the limited outcomes data, SCAD survivors typically have a good long-term prognosis. Majority of cases result in spontaneous healing, with improvement starting after several weeks and resolution at approximately 1-2 years.[4] However, there is an increased risk for recurrent SCAD events as well as other major cardiovascular events.[5]
Complications
Complications include:
- Extension of dissection(s)
- Recurrent dissection(s)
- Myocardial infarction
- Congestive heart failure
- Unstable ventricular arrhythmias
- Sudden cardiac death
Prognosis
Good prognosis is associated with:
- Small, limited dissections
- Incomplete or lesser degree of lumen obstruction
Bad prognosis is associated with:
- Left main coronary artery involvement
- Multi-vessel involvement
Long term survival after an index SCAD episode appears to be better compared with that of acute coronary syndrome. However, rates of major adverse cardiac events (MACE) resulting from index episode and complications are similar.
In the current literature, the prognosis of SCAD has been determined according to the small case series including different treatment options. According to a recent 168 patient-cohort study, in hospital MI rate was 4.5% and long term major adverse coronary events have been reported as 20%. [6] PCI has failed in one-third of cases. [7] In hospital prognosis was better in the conservative treatment group when compared with patients managed with percutaneous coronary intervention (PCI).[6] [8]
References
- ↑ Alfonso, Fernando; Bastante, Teresa; Rivero, Fernando; Cuesta, Javier; Benedicto, Amparo; Saw, Jacqueline; Gulati, Rajiv (2014). "Spontaneous Coronary Artery Dissection". Circulation Journal. 78 (9): 2099–2110. doi:10.1253/circj.CJ-14-0773. ISSN 1346-9843.
- ↑ Saw, J.; Aymong, E.; Sedlak, T.; Buller, C. E.; Starovoytov, A.; Ricci, D.; Robinson, S.; Vuurmans, T.; Gao, M.; Humphries, K.; Mancini, G. B. J. (2014). "Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes". Circulation: Cardiovascular Interventions. 7 (5): 645–655. doi:10.1161/CIRCINTERVENTIONS.114.001760. ISSN 1941-7640.
- ↑ Rogowski, Sebastian; Maeder, Micha T.; Weilenmann, Daniel; Haager, Philipp K.; Ammann, Peter; Rohner, Franziska; Joerg, Lucas; Rickli, Hans (2017). "Spontaneous Coronary Artery Dissection". Catheterization and Cardiovascular Interventions. 89 (1): 59–68. doi:10.1002/ccd.26383. ISSN 1522-1946.
- ↑ Saw J (2014). "Coronary angiogram classification of spontaneous coronary artery dissection". Catheter Cardiovasc Interv. 84 (7): 1115–22. doi:10.1002/ccd.25293. PMID 24227590.
- ↑ Tweet, MS.; Hayes, SN.; Pitta, SR.; Simari, RD.; Lerman, A.; Lennon, RJ.; Gersh, BJ.; Khambatta, S.; Best, PJ. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851. Unknown parameter
|month=ignored (help) - ↑ 6.0 6.1 Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D; et al. (2014). "Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes". Circ Cardiovasc Interv. 7 (5): 645–55. doi:10.1161/CIRCINTERVENTIONS.114.001760. PMID 25294399.
- ↑ Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS; et al. (2014). "Spontaneous coronary artery dissection: revascularization versus conservative therapy". Circ Cardiovasc Interv. 7 (6): 777–86. doi:10.1161/CIRCINTERVENTIONS.114.001659. PMID 25406203.
- ↑ Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ; et al. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.