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Management Algorithm for Spontaneous Coronary Artery Dissection ^[1]

Spontaneous Coronary Artery Dissection (SCAD)

Stable, no high-risk feature (i.e., left main or proximal 2-vessel coronary artery dissection)

High-risk feature present

Left main dissection

Ongoing/recurrent ischemia

Ventricular tachycardia or fibrillation

Cardiogenic shock

Hemodynamically unstable?

No

Yes

Consider: Intra-aortic balloon pump, Extra corporeal membrane oxygenation, Left ventricular assist device, Implantable cardioverter defibrillator

Isolated Left Main

Involving Left Anterior Descending (LAD) +/or circumflex

Is percutaneous coronary intervention (PCI) feasible?

No

Yes

Ostial LAD or ≥ 2 proximal SCAD?

Conservative therapy

PCI

Coronary artery bypassing

Conservative therapy

PCI

Adjunctive medical therapy
Aspirin and beta-blocker (± clopidogrel, ACEI/ARB, statin)

Monitor in-hospital for 3 to 5 days

↑ 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.

[pmid25406203-1] 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.

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-While Type 1 SCAD has a pathognomonic appearance on angiography, Type 2 may be and Type 3 typically is indistinguishable from [[atherosclerosis]]. Risk factors and patient history may help determine diagnosis. Intracoronary imaging provides the most objective tool in differentiating between SCAD and [[atheroma]].<ref name="pmid25774346">{{cite journal| author=Yip A, Saw J| title=Spontaneous coronary artery dissection-A review. | journal=Cardiovasc Diagn Ther | year= 2015 | volume= 5 | issue= 1 | pages= 37-48 | pmid=25774346 | doi=10.3978/j.issn.2223-3652.2015.01.08 | pmc=4329168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25774346  }} </ref><ref name="BuccheriPiraino2016">{{cite journal|last1=Buccheri|first1=Dario|last2=Piraino|first2=Davide|last3=Latini|first3=Roberto A.|last4=Andolina|first4=Giuseppe|last5=Cortese|first5=Bernardo|title=Spontaneous coronary artery dissections: A call for action for an underestimated entity|journal=International Journal of Cardiology|volume=214|year=2016|pages=333–335|issn=01675273|doi=10.1016/j.ijcard.2016.03.131}}</ref>
+===Management Algorithm for Spontaneous Coronary Artery Dissection <ref name="pmid25406203">{{cite journal| author=Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al.| title=Spontaneous coronary artery dissection: revascularization versus conservative therapy. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 6 | pages= 777-86 | pmid=25406203 | doi=10.1161/CIRCINTERVENTIONS.114.001659 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25406203  }} </ref> ===
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+{{Familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | | | | | | | A01 | A01=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">'''Spontaneous Coronary Artery Dissection (SCAD)'''</div>}}
+{{Familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|.| }}
+{{Familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | B01 | | | | | | | | | | B02 | B01= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">'''Stable, no high-risk feature (i.e., left main or proximal 2-vessel coronary artery dissection)'''</div>|B02= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;"> '''High-risk feature present'''</div>}}
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+{{familytree | | | |!| | | | | | | |,|-|-|-|^|-|-|-|v|-|-|-|v|-|-|-|.|}}
+{{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px background: #FFFFFF;| | | |!| | | | | | | C01 | | | | | | C02 | | C03 | | C04 | C01=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">Left main dissection</div>|C02=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">Ongoing/recurrent ischemia</div>|C03=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">Ventricular tachycardia or fibrillation</div>|C04=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 15px;">Cardiogenic shock</div>}}
+{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |`|-|v|-|'|}}
+{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | | | |!| }}
+{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | | | Z01 | Z01=Hemodynamically unstable?}}
+{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | | | |!| | }}
+{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |,|-|^|-|.|}}
+{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | D01 | | D02 | D01=No | D02=Yes }}
+{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | |!|}}
+{{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | E01 | E01=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 30px;">Consider: Intra-aortic balloon pump, Extra corporeal membrane oxygenation, Left ventricular assist device, Implantable cardioverter defibrillator</div>}}
+{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | |!|}}
+{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | |!|}}
+{{familytree | | | |!| | | | | |,|-|^|-|.| | | | | |`|-|v|-|'| | | |!|}}
+{{familytree | | | |!| | | | | |!| | | |!| | | | | | | |!| | | | | |!|}}
+{{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | |!| | | | | F01 | | F02 | | | | | | F03 |-|-|-|-|'| F01= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 30px;">Isolated Left Main</div>|F02= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">Involving Left Anterior Descending (LAD) +/or circumflex</div>| F03= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 30px;">Is percutaneous coronary intervention (PCI) feasible?</div>}}
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+{{familytree | | | |!| | | | | |!| | | |!| | | | | G01 | | | | G02 |G01=No | G02=Yes }}
+{{familytree | | | |!| | | | | |!| | | |!| | | | | |!| | | | | |!|}}
+{{familytree | | | |!| | | | | |!| | | |!| | | | | H01 | | | | |!|H01 = Ostial LAD or ≥ 2 proximal SCAD?}}
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+{{familytree | | | I02 | | | | I03 | | |`|-|-| I01 | | I02 | | I03 |I01=Coronary artery bypassing | I02=Conservative therapy | I03=PCI}}
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+{{familytree | | | | | | | | | | | | | |!|}}
+{{familytree | | | | | | | | | | | | | J01 | J01='''Adjunctive medical therapy''' <BR> Aspirin and beta-blocker (± clopidogrel, ACEI/ARB, statin)}}
+{{familytree | | | | | | | | | | | | | |!|}}
+{{familytree | | | | | | | | | | | | | K01 | K01=Monitor in-hospital for 3 to 5 days}}
+{{Family tree/end}}
+</div>

Sandbox gc: Difference between revisions

Revision as of 20:09, 26 February 2018

Management Algorithm for Spontaneous Coronary Artery Dissection [1]

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Management Algorithm for Spontaneous Coronary Artery Dissection ^[1]