Spontaneous coronary artery dissection epidemiology and demographics: Difference between revisions

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===Gender===
===Gender===


SCAD has a strong predilection for young women with no or minimal traditional atherosclerotic risk factors. Studies indicate that SCAD accounts for approximately 25% of women aged < 50 who present with [[myocardial infarction]].<ref name="pmid24726091">{{cite journal| author=Saw J, Aymong E, Mancini GB, Sedlak T, Starovoytov A, Ricci D| title=Nonatherosclerotic coronary artery disease in young women. | journal=Can J Cardiol | year= 2014 | volume= 30 | issue= 7 | pages= 814-9 | pmid=24726091 | doi=10.1016/j.cjca.2014.01.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24726091}}</ref>
SCAD has a strong predilection for young women with no or minimal traditional cardiovascular risk factors. It has been reported that SCAD is the most common non-atherosclerotic [[coronary artery disease]] in women <50 years of age and accounts for 24% of [[myocardial infarctions]].<ref name="pmid24726091">{{cite journal| author=Saw J, Aymong E, Mancini GB, Sedlak T, Starovoytov A, Ricci D| title=Nonatherosclerotic coronary artery disease in young women. | journal=Can J Cardiol | year= 2014 | volume= 30 | issue= 7 | pages= 814-9 | pmid=24726091 | doi=10.1016/j.cjca.2014.01.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24726091}}</ref>


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The [[left anterior descending artery]] (LAD) is the most commonly affected artery.<ref name="pmid19046896">{{cite journal |author=Vanzetto G, Berger-Coz E, Barone-Rochette G, ''et al.'' |title=Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients |journal=[[European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery]] |volume=35 |issue=2 |pages=250–4 |year=2009 |month=February |pmid=19046896 |doi=10.1016/j.ejcts.2008.10.023 |url=}}</ref><ref name="pmid18830003">{{cite journal |author=Kamran M, Guptan A, Bogal M|title=Spontaneous coronary artery dissection: case series and review |journal=J Invasive Cardiol |volume=20 |issue=10 |pages=553–9 |year=2008 |month=October |pmid=18830003|doi= |url=http://jic.epubxpress.com/link/jic/2008/oct/90?s=0}}</ref>  Although multivessel SCAD has been reported, single vessel SCAD is much more common. In women [[LAD]] is frequently involved<ref name="pmid19046896">{{cite journal |author=Vanzetto G, Berger-Coz E, Barone-Rochette G, ''et al.'' |title=Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients |journal=[[European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery]] |volume=35 |issue=2 |pages=250–4 |year=2009 |month=February |pmid=19046896 |doi=10.1016/j.ejcts.2008.10.023 |url=}}</ref> while in men [[right coronary artery]] is involved more often.


Observational studies have reported that SCAD is common among young women during their peripartum period<ref name="pmid19708230">{{cite journal |author=Fontanelli A, Olivari Z, La Vecchia L, ''et al.'' |title=Spontaneous dissections of coronary arteries and acute coronary syndromes: rationale and design of the DISCOVERY, a multicenter prospective registry with a case-control group |journal=[[Journal of Cardiovascular Medicine (Hagerstown, Md.)]] |volume=10 |issue=1 |pages=94–9 |year=2009 |month=January |pmid=19708230 |doi= |url=}}</ref> or in association with use of oral contraceptives. About 80% of SCAD cases reported so far have occurred in young women, especially those taking [[birth control|oral contraceptives]] [[OCP|(OCP]]s) or those in the peripartum period.<ref>{{cite journal |author=Narasimhan, S|title=Spontaneous coronary artery dissection (SCAD)|journal=IJTCVS |volume=20 |issue=4 |pages=189-91 |year=2004 |pmid= |doi= 10.1007/s12055-004-0084-x|url=http://medind.nic.in/ibq/t04/i4/ibqt04i4p189.pdf}}</ref><ref name="pmid8673763">{{cite journal |author=Zampieri P, Aggio S, Roncon L, ''et al.''|title=Follow up after spontaneous coronary artery dissection: a report of five cases |journal=[[Heart (British Cardiac Society)]] |volume=75 |issue=2|pages=206–9 |year=1996 |month=February |pmid=8673763 |pmc=484263 |doi= |url=}}</ref><ref name="pmid10700066">{{cite journal |author=Cohen DE, Strimike CL|title=A case of multiple spontaneous coronary artery dissections |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=49 |issue=3 |pages=318–20 |year=2000 |month=March |pmid=10700066 |doi= |url=}}</ref> Possible mechanisms underlying increased prevalence of SCAD in this population include: changes in the arterial wall media due to increasing hormone levels, shear stress during labor, fragmentation of reticulin fibers, loosening of ground substance, and hypertrophy of smooth muscle.<ref name="pmid19127318">{{cite journal |author=Van den Branden BJ, Bruggeling WA, Corbeij HM, Dunselman PH |title=Spontaneous coronary artery dissection in the postpartum period |journal=Neth Heart J |volume=16 |issue=12 |pages=412–4 |year=2008|month=December |pmid=19127318 |pmc=2612109 |doi= |url=}}</ref>
Observational studies have reported that SCAD is common among young women during their peripartum period<ref name="pmid19708230">{{cite journal |author=Fontanelli A, Olivari Z, La Vecchia L, ''et al.'' |title=Spontaneous dissections of coronary arteries and acute coronary syndromes: rationale and design of the DISCOVERY, a multicenter prospective registry with a case-control group |journal=[[Journal of Cardiovascular Medicine (Hagerstown, Md.)]] |volume=10 |issue=1 |pages=94–9 |year=2009 |month=January |pmid=19708230 |doi= |url=}}</ref> or in association with use of oral contraceptives. About 80% of SCAD cases reported so far have occurred in young women, especially those taking [[birth control|oral contraceptives]] [[OCP|(OCP]]s) or those in the peripartum period.<ref>{{cite journal |author=Narasimhan, S|title=Spontaneous coronary artery dissection (SCAD)|journal=IJTCVS |volume=20 |issue=4 |pages=189-91 |year=2004 |pmid= |doi= 10.1007/s12055-004-0084-x|url=http://medind.nic.in/ibq/t04/i4/ibqt04i4p189.pdf}}</ref><ref name="pmid8673763">{{cite journal |author=Zampieri P, Aggio S, Roncon L, ''et al.''|title=Follow up after spontaneous coronary artery dissection: a report of five cases |journal=[[Heart (British Cardiac Society)]] |volume=75 |issue=2|pages=206–9 |year=1996 |month=February |pmid=8673763 |pmc=484263 |doi= |url=}}</ref><ref name="pmid10700066">{{cite journal |author=Cohen DE, Strimike CL|title=A case of multiple spontaneous coronary artery dissections |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=49 |issue=3 |pages=318–20 |year=2000 |month=March |pmid=10700066 |doi= |url=}}</ref> Possible mechanisms underlying increased prevalence of SCAD in this population include: changes in the arterial wall media due to increasing hormone levels, shear stress during labor, fragmentation of reticulin fibers, loosening of ground substance, and hypertrophy of smooth muscle.<ref name="pmid19127318">{{cite journal |author=Van den Branden BJ, Bruggeling WA, Corbeij HM, Dunselman PH |title=Spontaneous coronary artery dissection in the postpartum period |journal=Neth Heart J |volume=16 |issue=12 |pages=412–4 |year=2008|month=December |pmid=19127318 |pmc=2612109 |doi= |url=}}</ref>

Revision as of 23:02, 1 December 2017

Spontaneous Coronary Artery Dissection Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Spontaneous coronary artery dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Angiography

CT

MRI

Echocardiography

Other Imaging Findings

Other Diagnostic Studies

Treatment

Treatment Approach

Medical Therapy

Percutaneous Coronary Intervention

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

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

Epidemiology and Demographics

Prevalence

The true prevalence of spontaneous coronary artery dissection (SCAD) remains unknown. The prevalence of SCAD is estimated at 0.2% in the whole population, 8.7% in women <50 years with acute coronary syndrome (ACS), and 10.8% in women <50 years with ST elevation-ACS.[1]

Incidence

The annual incidence of SCAD is estimated at 0.26 per 100,000 persons (0.33 in women and 0.18 in men), corresponding to 800 new cases of SCAD per year in the United States.[2] Retrospective angiographic registries have reported SCAD detection in approximately 0.1 to 1.1% of all coronary angiograms performed.[3][4][5][6][7][8][9][10]

Case Fatality Rate

The case fatality rate of SCAD is relatively low compared with other causes of ACS, with an estimated in-hospital mortality rate of 0 to 4%.[1]

Age

The prevalence of SCAD decreases with age, and is estimated at 7.6%, 4.0%, 2.1%, and 1.2% in women below the age of 40, 50, 60, and 70, respectively.[1]

Gender

SCAD has a strong predilection for young women with no or minimal traditional cardiovascular risk factors. It has been reported that SCAD is the most common non-atherosclerotic coronary artery disease in women <50 years of age and accounts for 24% of myocardial infarctions.[11]


Observational studies have reported that SCAD is common among young women during their peripartum period[12] or in association with use of oral contraceptives. About 80% of SCAD cases reported so far have occurred in young women, especially those taking oral contraceptives (OCPs) or those in the peripartum period.[13][8][14] Possible mechanisms underlying increased prevalence of SCAD in this population include: changes in the arterial wall media due to increasing hormone levels, shear stress during labor, fragmentation of reticulin fibers, loosening of ground substance, and hypertrophy of smooth muscle.[15]

References

  1. ↑ 1.0 1.1 1.2 Vanzetto, Gerald; Berger-Coz, Estelle; Barone-Rochette, Gilles; Chavanon, Olivier; Bouvaist, Helene; Hacini, Rachid; Blin, Dominique; Machecourt, Jacques (2009). "Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients". European Journal of Cardio-Thoracic Surgery. 35 (2): 250–254. doi:10.1016/j.ejcts.2008.10.023. ISSN 1010-7940.
  2. ↑ Tweet, MS.; Hayes, SN.; Pitta, SR.; Simari, RD.; Lerman, A.; Lennon, RJ.; Gersh, BJ.; Khambatta, S.; Best, PJ. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.
  3. ↑ Celik SK, Sagcan A, Altintig A, Yuksel M, Akin M, Kultursay H (2001). "Primary spontaneous coronary artery dissections in atherosclerotic patients. Report of nine cases with review of the pertinent literature". Eur J Cardiothorac Surg. 20 (3): 573–6. PMID 11509281.
  4. ↑ Alfonso, Fernando; Paulo, Manuel; Lennie, Vera; Dutary, Jaime; Bernardo, Esther; Jiménez-Quevedo, Pilar; Gonzalo, Nieves; Escaned, Javier; Bañuelos, Camino; Pérez-Vizcayno, María J.; Hernández, Rosana; Macaya, Carlos (2012). "Spontaneous Coronary Artery Dissection". JACC: Cardiovascular Interventions. 5 (10): 1062–1070. doi:10.1016/j.jcin.2012.06.014. ISSN 1936-8798.
  5. ↑ Mortensen, K.H.; Thuesen, L.; Kristensen, I.B.; Christiansen, E.H. (2009). "Spontaneous coronary artery dissection: A Western Denmark Heart Registry Study". Catheterization and Cardiovascular Interventions. 74 (5): 710–717. doi:10.1002/ccd.22115. ISSN 1522-1946.
  6. ↑ Pasalodos Pita J, Vazquez Gonzalez N, Perez Alvarez L, Vazquez Rodriguez JM, Castro Beiras A (1994). "Spontaneous coronary artery dissection". Cathet Cardiovasc Diagn. 32 (1): 27–32. PMID 8039214.
  7. ↑ Jorgensen MB, Aharonian V, Mansukhani P, Mahrer PR (1994). "Spontaneous coronary dissection: a cluster of cases with this rare finding". Am. Heart J. 127 (5): 1382–7. PMID 8172069.
  8. ↑ 8.0 8.1 Zampieri P, Aggio S, Roncon L, Rinuncini M, Canova C, Zanazzi G, Fiorencis R, Zonzin P (1996). "Follow up after spontaneous coronary artery dissection: a report of five cases". Heart. 75 (2): 206–9. PMC 484263. PMID 8673763.
  9. ↑ Hering D, Piper C, Hohmann C, Schultheiss HP, Horstkotte D (1998). "[Prospective study of the incidence, pathogenesis and therapy of spontaneous, by coronary angiography diagnosed coronary artery dissection]". Z Kardiol (in German). 87 (12): 961–70. PMID 10025069.
  10. ↑ Adams, Heath; Paratz, Elizabeth; Somaratne, Jithendra; Layland, Jamie; Burns, Andrew; Palmer, Sonny; MacIsaac, Andrew; Whitbourn, Robert (2017). "Different patients, different outcomes: A case-control study of spontaneous coronary artery dissection versus acute coronary syndrome". Journal of Interventional Cardiology. doi:10.1111/joic.12447. ISSN 0896-4327.
  11. ↑ Saw J, Aymong E, Mancini GB, Sedlak T, Starovoytov A, Ricci D (2014). "Nonatherosclerotic coronary artery disease in young women". Can J Cardiol. 30 (7): 814–9. doi:10.1016/j.cjca.2014.01.011. PMID 24726091.
  12. ↑ Fontanelli A, Olivari Z, La Vecchia L; et al. (2009). "Spontaneous dissections of coronary arteries and acute coronary syndromes: rationale and design of the DISCOVERY, a multicenter prospective registry with a case-control group". Journal of Cardiovascular Medicine (Hagerstown, Md.). 10 (1): 94–9. PMID 19708230. Unknown parameter |month= ignored (help)
  13. ↑ Narasimhan, S (2004). "Spontaneous coronary artery dissection (SCAD)" (PDF). IJTCVS. 20 (4): 189–91. doi:10.1007/s12055-004-0084-x.
  14. ↑ Cohen DE, Strimike CL (2000). "A case of multiple spontaneous coronary artery dissections". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 49 (3): 318–20. PMID 10700066. Unknown parameter |month= ignored (help)
  15. ↑ Van den Branden BJ, Bruggeling WA, Corbeij HM, Dunselman PH (2008). "Spontaneous coronary artery dissection in the postpartum period". Neth Heart J. 16 (12): 412–4. PMC 2612109. PMID 19127318. Unknown parameter |month= ignored (help)
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