Journal article
Spontaneous Coronary Artery Dissection: Angiographic Follow-Up and Long-Term Clinical Outcome in a Predominantly Medically Treated Population.
- Rogowski S Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
- Maeder MT Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
- Weilenmann D Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
- Haager PK Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
- Ammann P Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
- Rohner F Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
- Joerg L Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
- Rickli H Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
- 2015-12-29
Published in:
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. - 2017
antiplatelet therapy
conservative management
myocardial infarction
percutaneous coronary intervention
Acute Coronary Syndrome
Adult
Cardiovascular Agents
Coronary Angiography
Coronary Artery Bypass
Coronary Vessel Anomalies
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Out-of-Hospital Cardiac Arrest
Percutaneous Coronary Intervention
Predictive Value of Tests
Pregnancy
Recurrence
Registries
Risk Assessment
Risk Factors
Shock, Cardiogenic
Switzerland
Time Factors
Treatment Outcome
Vascular Diseases
English
OBJECTIVE
We sought to assess the angiographic and long-term clinical outcomes in a predominantly medically treated population with spontaneous coronary artery dissection (SCAD).
BACKGROUND
There are little data on the angiographic and long-term outcome in patients with SCAD.
METHODS
We studied 64 patients with SCAD (mean age 53 years, 94% females, three peripartum) with acute coronary syndrome who were treated using coronary bypass grafting (n = 1), percutaneous coronary intervention (n = 7), or medical therapy (n = 56). A repeat angiogram was performed in 40/64 (63%) patients. The median clinical follow-up was 4.5 years.
RESULTS
Five (8%) patients had a major cardiac event. One patient with peripartum left main SCAD and cardiogenic shock died during PCI. One patient with conservatively treated SCAD of the posterior descending artery suffered out-of-hospital cardiac arrest 16 days after the initial angiogram but survived. Three patients experienced a second SCAD in another vessel 3.7, 4.7, and 7.9 years after the index event while the initial dissection had healed. Thirty medically treated patients underwent a scheduled repeat angiogram showing healing of the dissection in all but one patient. After a median follow-up of 4.5 (1.8-8.4) years, all 63 patients surviving the index event were alive and free of symptoms suggestive of myocardial ischemia.
CONCLUSIONS
In general, the long-term outcome of patients with SCAD is excellent, and medical therapy can be safely applied in the majority of patients. However, SCAD can be a life-threatening and sometimes catastrophic event, and some patients experience early or late complications including SCAD of another vessel. © 2015 Wiley Periodicals, Inc.
We sought to assess the angiographic and long-term clinical outcomes in a predominantly medically treated population with spontaneous coronary artery dissection (SCAD).
BACKGROUND
There are little data on the angiographic and long-term outcome in patients with SCAD.
METHODS
We studied 64 patients with SCAD (mean age 53 years, 94% females, three peripartum) with acute coronary syndrome who were treated using coronary bypass grafting (n = 1), percutaneous coronary intervention (n = 7), or medical therapy (n = 56). A repeat angiogram was performed in 40/64 (63%) patients. The median clinical follow-up was 4.5 years.
RESULTS
Five (8%) patients had a major cardiac event. One patient with peripartum left main SCAD and cardiogenic shock died during PCI. One patient with conservatively treated SCAD of the posterior descending artery suffered out-of-hospital cardiac arrest 16 days after the initial angiogram but survived. Three patients experienced a second SCAD in another vessel 3.7, 4.7, and 7.9 years after the index event while the initial dissection had healed. Thirty medically treated patients underwent a scheduled repeat angiogram showing healing of the dissection in all but one patient. After a median follow-up of 4.5 (1.8-8.4) years, all 63 patients surviving the index event were alive and free of symptoms suggestive of myocardial ischemia.
CONCLUSIONS
In general, the long-term outcome of patients with SCAD is excellent, and medical therapy can be safely applied in the majority of patients. However, SCAD can be a life-threatening and sometimes catastrophic event, and some patients experience early or late complications including SCAD of another vessel. © 2015 Wiley Periodicals, Inc.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1002/ccd.26383
- PMID 26708825
- Persistent URL
- https://sonar.ch/global/documents/93200
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