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Marraki ZE, Mounaouir K, Marcolet P, Halet N, Didot V, Dechery T. Spontaneous coronary dissection: A rare etiology of acute coronary syndrome. Radiol Case Rep 2024; 19:1457-1462. [PMID: 38298906 PMCID: PMC10828590 DOI: 10.1016/j.radcr.2023.12.048] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024] Open
Abstract
Spontaneous coronary artery dissection is a rare etiology of acute coronary syndrome and falls into the category of myocardial infarction with no obstructive coronary arteries. It occurs mainly in young women with no cardiovascular risk factors. Diagnosis is often made by coronary angiography and sometimes by endocoronary imaging. the association of coronary dissection and ACS is rare, especially in men. The management is poorly codified and depends mainly on the habits of the practitioner, and may be medical, percutaneous or surgical. the outcome is often favorable, but sometimes there is a risk of recurrence with a guarded prognosis. In this context, we report the case of a 43-year-old patient with antecedent spontaneous coronary dissection, admitted to our unit for the management of acute coronary syndrome following recurrent coronary dissection.
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Affiliation(s)
- Zakaria el Marraki
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Tours, France
| | - Karim Mounaouir
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Casablanca, Morocco
| | - Pierre Marcolet
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Tours, France
| | - Nassim Halet
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Tours, France
| | - Valerian Didot
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Tours, France
| | - Thierry Dechery
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Tours, France
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2
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Méndez-Eirín E, Suárez-Ouréns Y, Rodríguez-Fernández JÁ. Spontaneous coronary artery dissection. Rev Clin Esp 2021; 221:297-305. [PMID: 38108498 DOI: 10.1016/j.rce.2020.11.004] [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] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022]
Abstract
Spontaneous coronary artery dissection is an underdiagnosed entity. It has been recognized as an important cause of acute coronary syndrome and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. This document provides an exhaustive review of the pathophysiology and etiology of this disease. In addition, we describe the main clinical characteristics of these patients, the diagnostic tests that must be performed, and the most appropriate treatment.
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Affiliation(s)
- E Méndez-Eirín
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España.
| | - Y Suárez-Ouréns
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | - J Á Rodríguez-Fernández
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
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3
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Méndez-Eirín E, Suárez-Ouréns Y, Rodríguez-Fernández JÁ. Spontaneous coronary artery dissection. Rev Clin Esp 2021; 221:297-305. [PMID: 33998517 DOI: 10.1016/j.rceng.2020.11.003] [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] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/12/2020] [Indexed: 10/21/2022]
Abstract
Spontaneous coronary artery dissection is an underdiagnosed entity. It has been recognized as an important cause of acute coronary syndrome and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. This document provides an exhaustive review of the pathophysiology and etiology of this disease. In addition, we describe the main clinical characteristics of these patients, the diagnostic tests that must be performed, and the most appropriate treatment.
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Affiliation(s)
- E Méndez-Eirín
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Y Suárez-Ouréns
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - J Á Rodríguez-Fernández
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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4
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Abstract
Spontaneous coronary artery dissection (SCAD) has been recognized as an emergent cause of acute coronary syndrome (ACS), myocardial infarction, and sudden death. Patients mostly affected by SCAD are individuals without or with few cardiovascular risk factors, particularly young women, thus suggesting a clearly different pathophysiology than the more common atherosclerosis. Present research efforts outlined an improved characterization of the prevalence, natural history, and clinical outcome of SCAD. Intracoronary imaging has been an important asset in this condition, providing an improved diagnostic and therapeutic understanding. Current evidences suggest not only that this condition is more common than previously thought but also that the clinical management could be distinctly different from ACS secondary to atherosclerosis. Both medical and interventional treatment should consider the different cause of ACS, as well as the clinical stability of the patient, taking into account that the risk of recurrence is particularly high, predominantly during the first few days after the acute event. Stemming from new scientific evidences in terms of pathophysiology, clinical approach, therapy strategies, and follow-up of SCAD, it is important to identify spontaneous coronary dissection in the differential diagnosis of ACS.
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Affiliation(s)
- Dario Calderone
- Divisione di Cardiologia, A.O.U. "Policlinico-Vittorio Emanuele", Università degli Studi di Catania, Catania, Italy
| | - Davide Capodanno
- Divisione di Cardiologia, A.O.U. "Policlinico-Vittorio Emanuele", Università degli Studi di Catania, Catania, Italy
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Abreu G, Galvão Braga C, Costa J, Azevedo P, Marques J. Spontaneous coronary artery dissection: A single-center case series and literature review. Rev Port Cardiol 2018; 37:707-13. [PMID: 29935775 DOI: 10.1016/j.repc.2017.07.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS). Better recognition and diagnosis has raised awareness of this condition. However, the pathophysiology of SCAD and its prognosis are still little understood. We aimed to investigate the characteristics and prognosis of patients with SCAD, and subsequently performed a review of literature. METHODS Single-center, retrospective study performed in patients hospitalized from January 2010 to December 2016 with suspected ACS (n=5002) whose final diagnosis was SCAD (n=27; 0.5%). RESULTS Patients with SCAD were mainly female (81.5%; n=22), with median age of 56. Predisposing factors were identified in 12 (44%) patients and precipitating factors in three (11.1%). Non-ST elevation myocardial infarction (NSTEMI) was the main form of presentation (51.9%). The left anterior descending artery (LAD) territory was the most commonly involved (n=12, 44.4%). Type 2 dissection was the most prevalent angiographic pattern (n=17, 63%). The majority of patients (n=15; 55.6%) were managed medically and the remaining patients underwent percutaneous coronary intervention (PCI) with drug-eluting stents. Seven patients re-infarcted while in the hospital. Over the median follow-up period of 20 months, 7.4% of patients (n=2) had symptoms of heart failure (HF) and 14.8% developed ACS (in three patients the event occurred in a coronary territory other than that of the index case, and in one patient it occurred in the previously affected territory). There were no deaths. CONCLUSION In the studied population, SCAD was more prevalent in middle-aged women. Despite the high prevalence of in-hospital re-infarction or during follow-up, the prognosis was good overall.
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Moon SK, Lee SU, Yang DH, Bak CM, Jo SH, Kim SS, Kang DG, Cho SK. Multivessel spontaneous coronary artery dissection presenting as acute myocardial infarction. Korean J Intern Med 2018; 33:629-631. [PMID: 27093980 PMCID: PMC5943642 DOI: 10.3904/kjim.2015.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 09/30/2015] [Accepted: 12/22/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Seung Uk Lee
- Correspondence to Seung Uk Lee, M.D. Division of Cardiology, Department of Internal Medicine, Kwangju Christian Hospital, 37 Yangnim-ro, Nam-gu, Gwangju 61661, Korea Tel: +82-62-650-5230 Fax: +82-62-650-5116 E-mail:
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Paratz ED, Kao C, MacIsaac AI, Somaratne J, Whitbourn R. Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review. Int J Cardiol Heart Vasc 2018; 18:1-6. [PMID: 29750179 PMCID: PMC5941240 DOI: 10.1016/j.ijcha.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 12/13/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is defined as SCAD occurring during pregnancy or within 3 months post-partum. Earlier systematic reviews have suggested a high maternal and foetal mortality rate. We undertook a structured systematic review of P-SCAD demographics, management and maternal and foetal outcomes. METHODS Case study identification was conducted according to PRISMA guidelines, with screening of all published P-SCAD cases not meeting pre-defined exclusion criteria. Of two hundred and seventy-three publications screened, one hundred and thirty-eight cases met inclusion criteria. Cases were allocated to one of three time periods; 1960-85 (twenty cases) reflecting early management of P-SCAD, 1986-2005 (forty-two cases) reflecting recent management, and 2006-16 (seventy-six cases), reflecting contemporary management. RESULTS The only significant demographic change in women experiencing P-SCAD over the last 50 years was an increasing proportion of primigravidas (p = 0.02). Management and outcomes, however, have altered significantly. Emergent angiography (p < 0.0001), reduced thrombolysis (p = 0.006) and increasingly conservative or percutaneous management (p < 0.0001) are associated with dramatic reductions in maternal mortality (85% in earliest reports to 4% in the last decade, p < 0.0001) and foetal mortality (50% in earliest reports to 0.0% in the last decade, p = 0.023). CONCLUSION This systematic review of temporal changes in presentation, management and outcomes of P-SCAD represents the widest range of variables analysed in the largest cohort of P-SCAD patients to date. In the setting of earlier coronary angiography and increasingly conservative management, maternal and foetal survival rates continue to improve.
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Affiliation(s)
| | - Chien Kao
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | | | - Robert Whitbourn
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
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8
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Shan P, Huang W, Hoosen R, Zhou C, Mintz GS, Fu G. Spontaneous dissection in the left main coronary artery. Am J Emerg Med 2018; 36:907.e1-907.e3. [PMID: 29478722 DOI: 10.1016/j.ajem.2018.01.065] [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] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/23/2018] [Indexed: 10/18/2022] Open
Abstract
We present two cases of spontaneous left main stem coronary artery dissection. One was underdiagnosed with suboptimal percutaneous coronary artery intervention followed by acute vessel occlusion again during the hospitalization. The other one was identified and confirmed by intravascular ultrasound, followed by conservative medical treatment, with completed healing of SCAD during two-month follow up.
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Affiliation(s)
- Peiren Shan
- Department of Cardiology, Sir Run Run Shaw Hospital Affiliated to Medicine College of Zhejiang University, PR China
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, PR China
| | - Rukhsaar Hoosen
- Department of Cardiology, Sir Run Run Shaw Hospital Affiliated to Medicine College of Zhejiang University, PR China
| | - Changzuan Zhou
- Department of Cardiology, Sir Run Run Shaw Hospital Affiliated to Medicine College of Zhejiang University, PR China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, United States
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital Affiliated to Medicine College of Zhejiang University, PR China.
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9
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Benamer H, Bouzid MA, Dufay A, Akodad M, Russel S, Halna du Fretay X, Haziza F. [Ischemic stroke related to spontaneous]. Ann Cardiol Angeiol (Paris) 2017; 66:415-420. [PMID: 29096901 DOI: 10.1016/j.ancard.2017.10.002] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiovascular disease in women is a particularly complex pathology especially in the youngest population. The clinical presentation of acute coronary syndromes is sometimes misleading and does not necessarily point to the potential presence of cardiac disease given the frequent absence of cardiovascular risks. Such complexity results in delayed diagnosis, which worsens the outcome of myocardial infarction and generates complications related to the absence of coronary revascularization. We report the case of a patient who suffered an (undiagnosed) apical myocardial infarction that went undetected and was complicated by a voluminous intraventricular thrombus with embolus migration in the cerebral circulation resulting in an ischemic accident. The combination of these two pathologies make their therapeutic management particularly difficult. As widely reported in the literature, the outcome of myocardial infarction in women is poorer than in their male counterparts for a number of reasons. We can assume that in the youngest patients, another physiopathological mechanism is often involved, namely, the occurrence of hematoma and spontaneous coronary dissection. Diagnosis is often difficult even with coronary angiography diagnosis. As shown in the case reported here, initial examination results, if not thoroughly analyzed, may be erroneously interpreted as normal. It is also likely that the presence of hematoma or coronary wall dissection without any plaque rupture may negatively influence the outcome owing to the implementation of inappropriate treatments. In conclusion, in patients presenting with an ischemic cerebral accident, meticulous cardiac examination must be performed even in young women with no cardiovascular risk factors given that the occurrence of hematoma or coronary dissection may contribute to the formation of mural thrombi in the setting of myocardial infarction. Cardiac MRI seems to be particularly effective in the diagnosis of myocardial infarction complicated by the presence of intracavitary thrombi.
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Affiliation(s)
- H Benamer
- ICPS groupe Ramsay, 6, avenue du Noyer-Lambert, 91300 Massy, France; ICV-GVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Sureness, France.
| | - M A Bouzid
- ICV-GVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Sureness, France
| | - A Dufay
- Hôpital Foch, 40, rue Worth, 92150 Sureness, France
| | - M Akodad
- ICPS groupe Ramsay, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - S Russel
- Hôpital Foch, 40, rue Worth, 92150 Sureness, France
| | - X Halna du Fretay
- Hôpital Foch, 40, rue Worth, 92150 Sureness, France; Centre hospitalier universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France
| | - F Haziza
- Hôpital Foch, 40, rue Worth, 92150 Sureness, France
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10
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Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS); its prevalence is estimated to be less than 3%. It is defined as a separation within the coronary arterial wall secondary to intramural bleeding with or without intimal tear, creating a false channel. It mainly affects young subjects, mainly women, without coronary atherosclerosis or risk factors for atherosclerosis. However, the occurrence of spontaneous dissection due to atheromatous disease is possible. We here report 2 cases of spontaneous coronary dissection, in order to discuss its pathogenesis, factors favoring its occurrence, its clinical presentation and its therapeutic management.
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Affiliation(s)
- Abdelouahab Elkasimi
- Service de Cardiologie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Université Mohamed Premier, Maroc
| | - Ghizlane Elouazzani
- Service de Cardiologie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Université Mohamed Premier, Maroc
| | - Anas Hbali
- Service de Cardiologie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Université Mohamed Premier, Maroc
| | - Nabila Ismaili
- Service de Cardiologie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Université Mohamed Premier, Maroc
| | - Nouha Elouafi
- Service de Cardiologie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Université Mohamed Premier, Maroc
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11
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Tokatli A, Tatli E, Can Y, Pabuccu T. Spontaneous left main coronary artery dissection. Indian Heart J 2016; 68:184-5. [PMID: 27133330 DOI: 10.1016/j.ihj.2015.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 11/17/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a very rare clinical condition. Physiopathology of SCAD is still mostly unclear. Clinical presentation of SCAD ranges from atypical symptoms to sudden cardiac death. The diagnosis of dissection is generally made by using conventional coronary angiography. Invasive or conservative treatment is reasonable.
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Affiliation(s)
- Alptug Tokatli
- Golcuk Military Hospital, Department of Cardiology, Kocaeli, Turkey.
| | - Ersan Tatli
- Sakarya University, Department of Cardiology, Sakarya, Turkey
| | - Yusuf Can
- Sakarya University, Department of Cardiology, Sakarya, Turkey
| | - Turker Pabuccu
- Sakarya University, Department of Cardiology, Sakarya, Turkey
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12
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Cerrato E, Tomassini F, Rolfo C, Gagnor A, Varbella F. Spontaneous coronary artery dissection treated with biovascular scaffolds guided by intravascular ultrasounds imaging. Cardiovasc Interv Ther 2016; 32:186-189. [PMID: 27023796 DOI: 10.1007/s12928-016-0391-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/07/2016] [Indexed: 11/24/2022]
Abstract
We reported a case of a fit and active 48 years' old woman presented with acute coronary syndrome due to a spontaneous coronary dissection (SCAD) treated with bioresorbable scaffolds (BVS) implantation guided by intravascular ultrasounds (IVUS) with immediate and long-term good results.
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Affiliation(s)
- Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.
| | | | - Cristina Rolfo
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Andrea Gagnor
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
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13
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Benamer H, Motreff P, Jessen P, Piquet M, Haziza F, Chevalier B. [Women and acute coronary syndrome with ST elevation: Excess mortality related to longer delays and spontaneous coronary dissection]. Ann Cardiol Angeiol (Paris) 2015; 64:460-466. [PMID: 26514723 DOI: 10.1016/j.ancard.2015.09.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The outcome of patients with ST elevation acute coronary syndrome (ACS) has been increasingly improving in the general population over the past few decades. However, detailed analysis of the results show that the reduction in mortality rates is higher in males compared to their female counterparts. The excess mortality rate observed in women, though sometimes questioned, has been widely reported in the literature. The higher mortality rate observed in women with ST elevation ACS can be explained by the presence of aggravating clinical factors such as older age, a higher percentage of diabetics, and a higher frequency of cardiogenic shock. Other factors pertaining to patient management seem to negatively impact the outcome. These factors include a lower use of reperfusion strategies, longer time to treatment mainly as a result of diagnostic uncertainty with respect to a disease, which is believed to affect principally the male gender. The doubts that female patients themselves and their families have about the nature of their symptoms are also present in the medical environment but cease to exist in the catheterization laboratory. This is illustrated in the first clinical case that we present here. Coronary reperfusion is the cornerstone of the therapeutic management of MI. In this context, bleeding complications associated with the implemented treatments can also result in an increased mortality rate in this more vulnerable population. When all the factors likely to influence the prognosis are taken into account, excess mortality seems to persist in women, especially in younger patients. As described in the second clinical case, a distinct physio-pathological factor, more frequent in women, could account for this higher mortality rate. Indeed, spontaneous coronary dissection and intramural hematoma are not always easy to diagnose and may not be adequately managed by reperfusion treatments. In addition, these coronary reperfusion strategies are probably not adapted to this type of ACS. It is, therefore, very important to identify them by angiography coupled with intra-coronary imaging examination when necessary and to carry out further research to adjust our PCI techniques to this pathology.
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Affiliation(s)
- H Benamer
- ICPS, 6, avenue du Noyer-Lambert-à-Massy, 91300 Massy, France; IVC-GVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - P Motreff
- CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P Jessen
- IVC-GVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France
| | - M Piquet
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - F Haziza
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - B Chevalier
- ICPS, 6, avenue du Noyer-Lambert-à-Massy, 91300 Massy, France
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14
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Sengottuvelu G, Rajendran R, Majumdar D. Optical coherence tomogram of spontaneous coronary artery dissection managed with drug eluting stent. Indian Heart J 2014; 66:247-8. [PMID: 24814129 DOI: 10.1016/j.ihj.2014.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- G Sengottuvelu
- Senior Consultant Cardiologist, Department of Cardiology, Apollo Hospitals, Chennai 06, India.
| | - Ravindran Rajendran
- Associate Consultant Cardiologist, Department of Cardiology, Apollo Hospitals, Chennai 06, India
| | - Debdatta Majumdar
- Associate Consultant Cardiologist, Department of Cardiology, Apollo Hospitals, Chennai 06, India
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15
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Alkhouli M, Huda N, Bashir R, Patil P, O'Murchu B. Left main coronary artery compression syndrome and spontaneous coronary artery dissection: coincidence or pathologic association? Heart Lung 2014; 43:284-5. [PMID: 24751338 DOI: 10.1016/j.hrtlng.2014.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/09/2014] [Accepted: 03/15/2014] [Indexed: 11/17/2022]
Abstract
Left main coronary artery compression syndrome (LMCS) in patients with severe pulmonary arterial hypertension (PAH) is an unusual, and often a missed cause of exertional angina. Spontaneous coronary dissection (SCD) is a rare cause of acute coronary syndrome of unknown etiology, with predilection to women in the 20s-40s. Weather the co-presence of LMCS and SCD in certain patients is a coincidence or of pathological significance is not known. The optimal management strategy of each of these conditions remains controversial. We report a case of SCD in a patient with PAH and LMCS, successfully treated with conservative medical therapy.
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Affiliation(s)
- Mohamad Alkhouli
- Cardiology Division, Temple University School of Medicine, 3041 N. Broad Street, Suite 945, Parkinson Pavilion, Philadelphia, PA 19140, USA.
| | - Nazmul Huda
- Cardiology Division, Temple University School of Medicine, 3041 N. Broad Street, Suite 945, Parkinson Pavilion, Philadelphia, PA 19140, USA
| | - Riyaz Bashir
- Cardiology Division, Temple University School of Medicine, 3041 N. Broad Street, Suite 945, Parkinson Pavilion, Philadelphia, PA 19140, USA
| | - Pravin Patil
- Cardiology Division, Temple University School of Medicine, 3041 N. Broad Street, Suite 945, Parkinson Pavilion, Philadelphia, PA 19140, USA
| | - Brian O'Murchu
- Cardiology Division, Temple University School of Medicine, 3041 N. Broad Street, Suite 945, Parkinson Pavilion, Philadelphia, PA 19140, USA
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16
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Abstract
Acute coronary syndrome (ACS) during pregnancy and the post-partum period are weighed by a high mortality rate for the mother and foetus. They should be considered as multifactorial diseases with a special role for sexual hormones. In this setting, ACS is mostly related to an early atherosclerotic disease, even if other conditions are responsible. Indeed, an important part is due to spontaneous coronary artery dissection, more common during delivery and the post-partum period. In the remaining situation, an isolated intracoronary thrombus or a normal angiographic pattern can be found at angiography. Pathophysiology is still uncertain with different hypothetical mechanisms. Prompt diagnosis of ACS and aetiology are essential for an optimal therapeutic strategy. Difficulties in treatment management is a matter for debate, especially in pre-partum women. In the last two decades improvements of diagnostic tools, coronary angiography and subsequent percutaneous treatment have changed the natural history of this rare condition.
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Affiliation(s)
- Gianfranco Aprigliano
- Interventional Cardiovascular Unit, Cardiology Department, Istituto Clinico Città Studi, Milan, Italy
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Appleby CE, Barolet A, Ing D, Ross J, Schwartz L, Seidelin P, Silversides C, Horlick E. Contemporary management of pregnancy-related coronary artery dissection: A single-centre experience and literature review. Exp Clin Cardiol 2009; 14:e8-e16. [PMID: 19492033 PMCID: PMC2689090] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 02/18/2009] [Indexed: 05/27/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is an infrequent event that is most commonly associated with pregnant women or those in the postpartum period. Because of its rarity, the literature describing this condition is confined to sporadic case reports, with few reporting long-term follow-up, and no clear consensus exists on the optimal treatment strategy for these patients. The present article reports a single-centre experience with SCAD, highlighting the issues surrounding its management with a brief description of five cases of pregnancy-associated coronary dissection. The treatment used in these cases ranged from a conservative medical approach to surgical and percutaneous intervention, with one patient proceeding to transplantation. Four of the cases have long-term angiographic follow-up.In addition, a comprehensive review of all previously published cases is presented, and temporal trends in the management strategy are highlighted. Possible pathophysiological mechanisms pertaining to this condition, and the complex diagnostic and therapeutic issues involved, which may affect both patient and fetus, are discussed. Finally, an optimal approach to patients with SCAD, informed by our experience and literature review, is described.
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Affiliation(s)
- Clare E Appleby
- Correspondence: Dr Clare E Appleby, Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom. E-mail
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