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Sumner JA, Kim ESH, Wood MJ, Chi G, Nolen J, Grodzinsky A, Gornik HL, Kadian-Dodov D, Wells BJ, Hess CN, Lewey J, Tam L, Henkin S, Orford J, Wells G, Kumbhani DJ, Lindley KJ, Gibson CM, Leon KK, Naderi S. Posttraumatic Stress Disorder After Spontaneous Coronary Artery Dissection: A Report of the International Spontaneous Coronary Artery Dissection Registry. J Am Heart Assoc 2024; 13:e032819. [PMID: 38533943 DOI: 10.1161/jaha.123.032819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Myocardial infarction secondary to spontaneous coronary artery dissection (SCAD) can be traumatic and potentially trigger posttraumatic stress disorder (PTSD). In a large, multicenter, registry-based cohort, we documented prevalence of lifetime and past-month SCAD-induced PTSD, as well as related treatment seeking, and examined a range of health-relevant correlates of SCAD-induced PTSD. METHODS AND RESULTS Patients with SCAD were enrolled in the iSCAD (International SCAD) Registry. At baseline, site investigators completed medical report forms, and patients reported demographics, medical/SCAD history, psychosocial factors (including SCAD-induced PTSD symptoms), health behaviors, and health status via online questionnaires. Of 1156 registry patients, 859 patients (93.9% women; mean age, 52.3 years) completed questionnaires querying SCAD-induced PTSD. Nearly 35% (n=298) of patients met diagnostic criteria for probable SCAD-induced PTSD in their lifetime, and 6.4% (n=55) met criteria for probable past-month PTSD. Of 811 patients ever reporting any SCAD-induced PTSD symptoms, 34.8% indicated seeking treatment for this distress. However, 46.0% of the 298 patients with lifetime probable SCAD-induced PTSD diagnoses reported never receiving trauma-related treatment. Younger age at first SCAD, fewer years since SCAD, being single, unemployed status, more lifetime trauma, and history of anxiety were associated with greater past-month PTSD symptom severity in multivariable regression models. Greater past-month SCAD-induced PTSD symptoms were associated with greater past-week sleep disturbance and worse past-month disease-specific health status when adjusting for various risk factors. CONCLUSIONS Given the high prevalence of SCAD-induced PTSD symptoms, efforts to support screening for these symptoms and connecting patients experiencing distress with empirically supported treatments are critical next steps. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04496687.
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Affiliation(s)
- Jennifer A Sumner
- Department of Psychology University of California, Los Angeles Los Angeles CA USA
| | - Esther S H Kim
- Division of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA
| | - Malissa J Wood
- Division of Cardiology Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | - Gerald Chi
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | | | - Anna Grodzinsky
- Saint Luke's Mid America Heart Institute, Muriel I. Kauffman Women's Heart Center University of Missouri-Kansas City Kansas City MO USA
| | - Heather L Gornik
- Harrington Heart & Vascular Institute, University Hospitals, Division of Cardiovascular Medicine Case Western Reserve University Cleveland OH USA
| | - Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health Icahn School of Medicine at Mount Sinai New York NY USA
| | - Bryan J Wells
- Division of Cardiology, Department of Medicine Emory University School of Medicine Atlanta GA USA
| | - Connie N Hess
- Division of Cardiology, Department of Medicine University of Colorado School of Medicine Aurora CO USA
| | - Jennifer Lewey
- Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
| | - Lori Tam
- Providence Heart Institute Portland OR USA
| | - Stanislav Henkin
- Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH USA
| | - James Orford
- Intermountain Heart Institute, Intermountain Medical Center Murray UT USA
| | - Gretchen Wells
- Division of Cardiovascular Medicine, Department of Medicine University of Kentucky Lexington KY USA
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX USA
| | - Kathryn J Lindley
- Division of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA
| | - C Michael Gibson
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | | | - Sahar Naderi
- Division of Cardiology Kaiser Permanente San Francisco CA USA
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La S, Beltrame J, Tavella R. Sex-specific and ethnicity-specific differences in MINOCA. Nat Rev Cardiol 2024; 21:192-202. [PMID: 37775559 DOI: 10.1038/s41569-023-00927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/01/2023]
Abstract
Suspected myocardial infarction with non-obstructive coronary arteries (MINOCA) has received increasing attention over the past decade. Given the heterogeneity in the mechanisms underlying acute myocardial infarction in the absence of obstructive coronary arteries, the syndrome of MINOCA is considered a working diagnosis that requires further investigation after diagnostic angiography studies have been performed, including coronary magnetic resonance angiography and functional angiography. Although once considered an infrequent and low-risk form of myocardial infarction, recent data have shown that the prognosis of MINOCA is not as benign as previously assumed. However, despite increasing awareness of the condition, many questions remain regarding the diagnosis, risk stratification and treatment of MINOCA. Women seem to be more susceptible to MINOCA, but studies on the sex-specific differences of the disease are scarce. Similarly, ethnicity-specific factors might explain discrepancies in the observed prevalence or underlying pathophysiological mechanisms of MINOCA but data are also scarce. Therefore, in this Review, we provide an update on the latest evidence available on the sex-specific and ethnicity-specific differences in the clinical features, pathophysiological mechanisms, treatment and prognosis of MINOCA.
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Affiliation(s)
- Sarena La
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - John Beltrame
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Rosanna Tavella
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
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Petrović M, Miljković T, Ilić A, Kovačević M, Čanković M, Dabović D, Stojšić Milosavljević A, Čemerlić Maksimović S, Jaraković M, Andrić D, Golubović M, Bjelobrk M, Bjelić S, Tadić S, Slankamenac J, Apostolović S, Djurović V, Milovančev A. Management and outcomes of spontaneous coronary artery dissection: a systematic review of the literature. Front Cardiovasc Med 2024; 11:1276521. [PMID: 38298759 PMCID: PMC10829101 DOI: 10.3389/fcvm.2024.1276521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
Background Contemporary management of spontaneous coronary artery dissection (SCAD) is still controversial. This systematic review of the literature aims to explore outcomes in the patients treated with conservative management vs. invasive strategy. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed when we extensively searched three electronic databases: PubMed, ScienceDirect, and Web of Science, for studies that compared conservative vs. invasive revascularization treatment outcomes for patients with SCAD from 2003 to 2023. The outcomes of interest were all-cause death and major adverse cardiovascular events (MACE), including acute coronary syndrome (ACS), heart failure (HF), need for additional revascularization, target vessel revascularization (TVR), SCAD recurrence, and stroke. Results The systematic review included 13 observational studies evaluating 1,801 patients with SCAD. The overall mean age was 49.12 +/- 3.41, and 88% were females. The overall prevalence of arterial hypertension was 33.2%, hyperlipidemia, 26.9%, smoking, 17.8%, and diabetes, 3.9%. Approximately 48.5% of the patients were diagnosed with non-ST elevated myocardial infarction (NSTEMI), 36.8% with ST elevated myocardial infarction (STEMI), 3.41% with unstable angina, 0.56% with stable angina, and 0.11% were diagnosed with various types of arrhythmias. The left anterior descending artery (LAD) was the most common culprit lesion in 51% of the patients. There were initially 65.2% of conservatively treated patients vs. 33.4% that underwent percutaneous coronary intervention (PCI) or 1.28% that underwent coronary artery bypass graft (CABG). SCAD-PCI revascularization was associated with a variable range of PCI failure. The most common complications were hematoma extension and iatrogenic dissection. SCAD-PCI revascularization frequently required three or more stents and had residual areas of dissection. The overall reported in-hospital and follow-up mortality rates were 1.2% and 1.3%, respectively. The follow-up range across studies was 7.3-75.6 months. The authors reported variable prevalence of MACE, recurrent SCAD up to 31%, ACS up to 27.4%, TVR up to 30%, repeat revascularization up to 14.7%, UA up to 13.3%, HF up to 17.4%, and stroke up to 3%. Conclusion Our results highlight that conservative treatment should be the preferred method of treatment in patients with SCAD. PCI revascularization is associated with a high prevalence of periprocedural complications. SCAD poses a considerable risk of MACE, mainly associated with TVR, ACS, and recurrent SCAD.
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Affiliation(s)
- Milovan Petrović
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Tatjana Miljković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Aleksandra Ilić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Mila Kovačević
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Milenko Čanković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Dragana Dabović
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Anastazija Stojšić Milosavljević
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | | | - Milana Jaraković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Dragica Andrić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Miodrag Golubović
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Marija Bjelobrk
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Snežana Bjelić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Snežana Tadić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Jelena Slankamenac
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Svetlana Apostolović
- Medical Faculty, University of Niš, Niš, Serbia
- Clinical Center of Niš, Cardiology Clinic, Niš, Serbia
| | - Vladimir Djurović
- Clinic of Nephrology and Clinical Immunology, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Aleksandra Milovančev
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
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Greer OYO, Anandanadesan R, Shah NM, Price S, Johnson MR. Cardiogenic shock in pregnancy. BJOG 2024; 131:127-139. [PMID: 37794623 DOI: 10.1111/1471-0528.17645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/06/2023] [Accepted: 08/20/2023] [Indexed: 10/06/2023]
Abstract
Cardiac disease complicates 1%-4% of pregnancies globally, with a predominance in low and middle-income countries (LMICs). Increasing maternal age, rates of obesity, cardiovascular comorbidities, pre-eclampsia and gestational diabetes all contribute to acquired cardiovascular disease in pregnancy. Additionally, improved survival in congenital heart disease (CHD) has led to increasing numbers of women with CHD undergoing pregnancy. Implementation of individualised care plans formulated through pre-conception counselling and based on national and international guidance have contributed to improved clinical outcomes. However, there remains a significant proportion of women of reproductive age with no apparent comorbidities or risk factors that develop heart disease during pregnancy, with no indication for pre-conception counselling. The most extreme manifestation of cardiac disease is cardiogenic shock (CS), where the primary cardiac pathology results in inadequate cardiac output and hypoperfusion, and is associated with significant mortality and morbidity. Key to management is early recognition, intervention to treat any potentially reversible underlying pathology and supportive measures, up to and including mechanical circulatory support (MCS). In this narrative review we discuss recent developments in the classification of CS, and how these may be adapted to improve outcomes of pregnant women with, or at risk of developing, this potentially lethal condition.
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Affiliation(s)
- Orene Y O Greer
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Rathai Anandanadesan
- Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Department of Critical Care, King's College Hospital, London, UK
| | - Nishel M Shah
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Susanna Price
- Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Mark R Johnson
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Chelsea & Westminster NHS Foundation Trust, London, UK
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5
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Dang Q, Othman F, Sheahen B, Marschner S, Psaltis P, Al-Lamee RK, Szirt R, Chong J, Zaman S. Regional and temporal variations of spontaneous coronary artery dissection care according to consensus recommendations: a systematic review and meta-analysis. Open Heart 2023; 10:e002379. [PMID: 38056913 DOI: 10.1136/openhrt-2023-002379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
AIM The first expert consensus documents on management of patients with spontaneous coronary artery dissection (SCAD) were published in 2018. Worldwide quality of care, as measured by adherence to these recommendations, has not been systematically reviewed. We aim to review the proportion of patients with SCAD receiving consensus recommendations globally, regionally and, determine differences in practice before and after 2018. METHODS AND RESULTS A systematic review was performed by searching four main databases (Medline, Embase, SCOPUS, CINAHL) from their inception to 16 June 2022. Studies were selected if they included patients with SCAD and reported at least one of the consensus document recommendations. 53 studies, n=8456 patients (mean 50.1 years, 90.6% female) were included. On random effects meta-analysis, 92.1% (95% CI 89.3 to 94.8) received at least one antiplatelet, 78.0% (CI 73.5 to 82.4) received beta-blockers, 58.7% (CI 52.3 to 65.1) received ACE inhibitors or aldosterone receptor blockers (ACEIs/ARBs), 54.4% (CI 45.4 to 63.5) were screened for fibromuscular dysplasia (FMD), and 70.2% (CI 60.8 to 79.5) were referred to cardiac rehabilitation. Except for cardiac rehabilitation referral and use of ACEIs/ARBs, there was significant heterogeneity in all other quality-of-care parameters, across geographical regions. No significant difference was observed in adherence to recommendations in studies published before and after 2018, except for lower cardiac rehabilitation referrals after 2018 (test of heterogeneity, p=0.012). CONCLUSION There are significant variations globally in the management of patients with SCAD, particularly in FMD screening. Raising awareness about consensus recommendations and further prospective evidence about their effect on outcomes may help improve the quality of care for these patients.
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Affiliation(s)
- Quan Dang
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Farrah Othman
- The University of Western Australia, Perth, Western Australia, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Brodie Sheahen
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Peter Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Medical and Health Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | | | - Richard Szirt
- St George Hospital, Kogarah, New South Wales, Australia
| | - James Chong
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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Caverley ZR, Tam LM. Spontaneous coronary artery dissection: An underrecognized cause of ACS. JAAPA 2023; 36:8-13. [PMID: 37943693 DOI: 10.1097/01.jaa.0000991340.13787.3c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
ABSTRACT Spontaneous coronary artery dissection (SCAD) is an underrecognized form of nonatherosclerotic acute coronary syndrome, mostly occurring in younger female patients. The knowledge base about the diagnosis and management of SCAD has grown over the past decade, but gaps remain in how best to approach this disease. This article reviews the research on the prevalence, presentation, and management of SCAD.
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Affiliation(s)
- Zachary R Caverley
- Zachary R. Caverley practices in cardiology at Providence Heart Clinic-Astoria (Ore.). Lori M. Tam practices cardiology at Providence St. Vincent Medical Center in Portland, Ore. The authors have disclosed no potential conflicts of interest, financial or otherwise
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7
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Kaddoura R, Cader FA, Ahmed A, Alasnag M. Spontaneous coronary artery dissection: an overview. Postgrad Med J 2023; 99:1226-1236. [PMID: 37773985 DOI: 10.1093/postmj/qgad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/26/2023] [Indexed: 10/01/2023]
Abstract
The prevalence of spontaneous coronary artery dissection (SCAD) has increased over the last decades in young adults presenting with acute coronary syndrome. Although the diagnostic tools, including intracoronary imaging, have permitted a more accurate diagnosis of SCAD, the prognosis and overall outcomes remain dismal. Furthermore, the disproportionate sex distribution affecting more women and the underdiagnosis in many parts of the world render this pathology a persistent clinical challenge, particularly since the management remains largely supportive with a limited and controversial role for percutaneous or surgical interventions. The purpose of this review is to summarize the available literature on SCAD and to provide insights into the gaps in knowledge and areas requiring further investigation.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fathima Aaysha Cader
- Department of Cardiology, Department of Cardiology, Kettering General Hospital, Kettering, Northants, NN16 8UZ, England
| | - Ashraf Ahmed
- Department of Internal Medicine, Bridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut 06610, United States
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital , Jeddah 21159, Saudi Arabia
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8
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Huart J, Stoenoiu MS, Zedde M, Pascarella R, Adlam D, Persu A. From Fibromuscular Dysplasia to Arterial Dissection and Back. Am J Hypertens 2023; 36:573-585. [PMID: 37379454 DOI: 10.1093/ajh/hpad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 06/30/2023] Open
Abstract
Fibromuscular dysplasia (FMD) is an idiopathic and systemic non-inflammatory and non-atherosclerotic arterial disease. Fifteen to 25% of patients with FMD present with arterial dissection in at least one arterial bed. Conversely, a substantial number of patients with renal, carotid, and visceral dissection have underlying FMD. Also, while few patients with FMD develop coronary artery dissection, lesions suggestive of multifocal FMD have been reported in 30-80% of patients with spontaneous coronary artery dissection (SCAD), and the relation between these two entities remains controversial. The frequent association of FMD with arterial dissection, both in coronary and extra-coronary arteries raises a number of practical and theoretical questions: (i) Are FMD and arterial dissections two different facets of the same disease or distinct though related entities? (ii) Is SCAD just a manifestation of coronary FMD or a different disease? (iii) What is the risk and which are predictive factors of developing arterial dissection in a patient with FMD? (iv) What proportion of patients who experienced an arterial dissection have underlying FMD, and does this finding influence the risk of subsequent arterial complications? In this review we will address these different questions using fragmentary, mostly cross-sectional evidence derived from large registries and studies from Europe and the United States, as well as arguments derived from demographics, clinical presentation, imaging, and when available histology and genetics. From there we will derive practical consequences for nosology, screening and follow-up.
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Affiliation(s)
- Justine Huart
- Division of Nephrology, University of Liège Hospital (ULiège CHU), University of Liège, Liège, Belgium
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Division of Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Maria S Stoenoiu
- Department of Internal Medicine, Rheumatology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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9
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Cano-Castellote M, Afanador-Restrepo DF, González-Santamaría J, Rodríguez-López C, Castellote-Caballero Y, Hita-Contreras F, Carcelén-Fraile MDC, Aibar-Almazán A. Pathophysiology, Diagnosis and Treatment of Spontaneous Coronary Artery Dissection in Peripartum Women. J Clin Med 2022; 11:jcm11226657. [PMID: 36431134 PMCID: PMC9692787 DOI: 10.3390/jcm11226657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an infrequent cause of nonobstructive ischemic heart disease in previously healthy young women and therefore is not usually considered in differential diagnoses. The overall incidence of SCAD in angiographic series is between 0.28 and 1.1%, with a clear predominance in young, healthy women (70%) of whom approximately 30% are in the postpartum period. In the United Kingdom, between 2008 and 2012, SCAD was the cause of 27% of acute myocardial infarctions during pregnancy, with a prevalence of 1.81 per 100,000 pregnancies. Regarding the mechanism of arterial obstruction, this may be due to the appearance of an intramural hematoma or to a tear in the intima of the arteries, both spontaneously. Although multiple diagnostic methods are available, it is suggested to include an appropriate anamnesis, an electrocardiogram in the first 10 min after admission to the service or the onset of symptoms, and subsequently, a CT angiography of the coronary arteries or urgent coronary angiography if the hemodynamic status of the patient allows it. Treatment should be individualized for each case; however, the appropriate approach is generally based on two fundamental pillars: conservative medical treatment with antiplatelet agents, beta-blockers, and nitrates, and invasive treatment with percutaneous coronary intervention for stent implantation or balloon angioplasty, if necessary.
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Affiliation(s)
- Marta Cano-Castellote
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - Diego Fernando Afanador-Restrepo
- Faculty of Distance and Virtual Education, Antonio José Camacho University Institution, Santiago de Cali 760016, Colombia
- ZIPATEFI Research Group, Faculty of Health Sciences and Sports, University Foundation of the Área Andina, Pereira 660001, Colombia
| | - Jhonatan González-Santamaría
- ZIPATEFI Research Group, Faculty of Health Sciences and Sports, University Foundation of the Área Andina, Pereira 660001, Colombia
- Faculty of Health Sciences, Technological University of Pereira, Pereira 660001, Colombia
- Nutrition Sciences Postgraduate, Faculty of Nutrition Sciences, University of Sinaloa, Culiacan 80019, Mexico
| | | | | | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
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10
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Abstract
Introduction: Spontaneous coronary artery dissection (SCAD) is a cause of non-atherosclerotic acute coronary syndrome and sudden cardiac death that predominantly impacts young and middle-aged women. In addition to the challenges of acute SCAD including arrhythmias, heart failure, and recurrent chest pain, de novo recurrent SCAD occurs in 5-29% of patients. Recurrent SCAD presents both a psychological burden and a significant cardiac risk to patients. Research regarding SCAD recurrence risk has been growing and can guide providers and patients alike.Areas covered: This review provides up-to-date information about many aspects of SCAD with a focus on SCAD recurrence. PubMed articles were reviewed through October 2020, with particular focus on clinical studies and original research. The resulting literature was scrutinized for information on SCAD recurrence. SCAD-associated conditions, genetic data, clinical characteristics, medications, and aspects of post-SCAD care are summarized.Expert Opinion: SCAD recurrence poses a concerning risk for patients with SCAD. Conditions such as hypertension and severe coronary tortuosity may be associated with recurrence. More research is needed to further elucidate risk factors for recurrence and clarify interventions, such as beta blocker therapy, that may reduce recurrence risk.
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Affiliation(s)
- Susan N Kok
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Marysia S Tweet
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Kronzer VL, Tarabochia AD, Lobo Romero AS, Tan NY, O'Byrne TJ, Crowson CS, Turley TN, Myasoedova E, Davis JM, Raphael CE, Gulati R, Hayes SN, Tweet MS. Lack of Association of Spontaneous Coronary Artery Dissection With Autoimmune Disease. J Am Coll Cardiol 2021; 76:2226-2234. [PMID: 33153582 DOI: 10.1016/j.jacc.2020.09.533] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Case reports and referral-based studies suggest spontaneous coronary artery dissection (SCAD) is associated with autoimmune diseases and causes 2% to 4% of acute coronary syndromes. OBJECTIVES This study determined the association of SCAD with autoimmune diseases, together with incidence and recurrence, in a population-based study. METHODS This case-control study took place from 1995 to 2018 within the Rochester Epidemiology Project. The study identified cases with SCAD from diagnosis codes and verified them using coronary angiography images, matching each case to 3 control subjects on age, sex, county, and years of medical history. Autoimmune disease history came from a validated, code-based definition. A multivariable logistic regression model calculated the odds ratio (OR) for SCAD among patients with a history of autoimmune disease, adjusting for race and body mass index. RESULTS The study identified 114 cases with SCAD (mean age 51 years and 90% women) and 342 matched control subjects. Autoimmune disease occurred in 13 (11%) cases with SCAD and 40 (12%) control subjects (p = 0.93). Even after adjustment, autoimmune diseases were not associated with SCAD (OR: 0.81; 95% confidence interval [CI]: 0.40 to 1.66). SCAD incidence between 2010 and 2018 (2.7 per 100,000; 95% CI: 1.7 to 3.7) was 10-fold higher than the incidence between 1995 and 2009 (0.3 per 100,000; 95% CI: 0.0 to 0.6). SCAD recurrence was 10% (95% CI: 3% to 16%) at 5 years. CONCLUSIONS These findings suggested SCAD pathogenesis is noninflammatory and screening for autoimmune diseases based on SCAD alone is not warranted. The code-based incidence of SCAD has increased over time, highlighting the importance of considering SCAD among patients with acute coronary syndromes.
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Affiliation(s)
- Vanessa L Kronzer
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas J O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Tamiel N Turley
- Molecular Pharmacology and Experimental Therapeutics Track, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota; Cardiovascular Genetics Research Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - John M Davis
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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