Spontaneous coronary artery dissection natural history, complications and prognosis
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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 and small case series suggest a dismal prognosis, with sudden cardiac death as the initial presentation in 28% of cases and an in-hospital mortality of 49%.[1] In contrast, data from recent studies demonstrate that the majority of SCAD lesions heal spontaneously over time and achieve complete resolution on repeat angiography within one month among stabilized patients who survive initial hospitalization.[2][3] The risk of recurrence has been reported in 10 to 30% of cases with a 3- to 10-year follow-up from different series that adopted a non-revascularization management approach.[4][2][5][6][7] In a recent large cohort with a median follow-up of 3.1 years, the rate of post-discharge major adverse cardiac event was estimated at 19.9% (approximately 6 events/100 person-years), with myocardial infarction (16.8%) and recurrent SCAD (10.4%) as the most frequent events.[7] Considering the favorable prognosis and the high failure rate of percutaneous coronary intervention in this scenario, the results support the initial conservative treatment strategy for clinically stable patients without left main artery involvement.
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%. [8] PCI has failed in one-third of cases. [9] In hospital prognosis was better in the conservative treatment group when compared with patients managed with percutaneous coronary intervention (PCI).[8] [10]
References
- ↑ Kolle, Patrick T.; Cliffe, Charles M.; Ridley, David J. (1998). "Immunosuppressive therapy for peripartum-type spontaneous coronary artery dissection: Case report and review". Clinical Cardiology. 21 (1): 40–46. doi:10.1002/clc.4960210108. ISSN 0160-9289.
- ↑ 2.0 2.1 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.
- ↑ Tweet, M. S.; Hayes, S. N.; Pitta, S. R.; Simari, R. D.; Lerman, A.; Lennon, R. J.; Gersh, B. J.; Khambatta, S.; Best, P. J. M.; Rihal, C. S.; Gulati, R. (2012). "Clinical Features, Management, and Prognosis of Spontaneous Coronary Artery Dissection". Circulation. 126 (5): 579–588. doi:10.1161/CIRCULATIONAHA.112.105718. ISSN 0009-7322.
- ↑ Tweet, M. S.; Eleid, M. F.; Best, P. J. M.; Lennon, R. J.; Lerman, A.; Rihal, C. S.; Holmes, D. R.; Hayes, S. N.; Gulati, R. (2014). "Spontaneous Coronary Artery Dissection: Revascularization Versus Conservative Therapy". Circulation: Cardiovascular Interventions. 7 (6): 777–786. doi:10.1161/CIRCINTERVENTIONS.114.001659. ISSN 1941-7640.
- ↑ Nakashima, Takahiro; Noguchi, Teruo; Haruta, Seiichi; Yamamoto, Yusuke; Oshima, Shuichi; Nakao, Koichi; Taniguchi, Yasuyo; Yamaguchi, Junichi; Tsuchihashi, Kazufumi; Seki, Atsushi; Kawasaki, Tomohiro; Uchida, Tatsuro; Omura, Nobuhiro; Kikuchi, Migaku; Kimura, Kazuo; Ogawa, Hisao; Miyazaki, Shunichi; Yasuda, Satoshi (2016). "Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris–Myocardial Infarction Multicenter Investigators in Japan". International Journal of Cardiology. 207: 341–348. doi:10.1016/j.ijcard.2016.01.188. ISSN 0167-5273.
- ↑ 7.0 7.1 Saw, Jacqueline; Humphries, Karin; Aymong, Eve; Sedlak, Tara; Prakash, Roshan; Starovoytov, Andrew; Mancini, G.B. John (2017). "Spontaneous Coronary Artery Dissection". Journal of the American College of Cardiology. 70 (9): 1148–1158. doi:10.1016/j.jacc.2017.06.053. ISSN 0735-1097.
- ↑ 8.0 8.1 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.