Spontaneous coronary artery dissection epidemiology and demographics

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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. Arzu Kalayci, M.D. [2]

Synonyms and keywords: SCAD

Overview

The annual incidence of spontaneous coronary artery dissection is estimated at 0.26 per 100,000 persons (0.33 in women and 0.18 in men), corresponding to approximately 800 new cases per year in the United States. The true prevalence of spontaneous coronary artery dissection in the general population remains unknown; however, retrospective angiographic registries have reported a SCAD detection rate of 0.1 to 1.1% among all coronary angiograms performed.

Epidemiology and Demographics

Prevalence

The true prevalence of spontaneous coronary artery dissection (SCAD) remains unknown because it is an under-diagnosed condition. Missed diagnoses may be driven by a low suspicion of acute coronary syndrome (ACS) in young female even in the presence of classic manifestations, limitations of current coronary angiographic techniques, and lack of clinician familiarity with the condition.[1]

The prevalence of SCAD reported by retrospective angiographic registries ranges from 0.2 to 2.0% among all ACS cases and from 8.7 to 35.0% among women <50 years with ACS.[2][3][4][5][6][7][8][9]

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 approximately 800 new cases per year in the United States.[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%.[2]

Age

The average age at diagnosis of SCAD in females ranges from 44 to 53 years, although patients may present with SCAD in their second through ninth decades of life.[1][11]


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.[2]

Gender

SCAD has a strong predilection for young women with no or minimal traditional cardiovascular risk factors. SCAD is one of the most common non-atherosclerotic coronary artery diseases in women <50 years of age and accounts for one-fourth of myocardial infarctions.[12] The risk of SCAD has been associated with pregnancy as well as the use of oral contraceptives.[13][14][15] Possible mechanisms underlying increased prevalence of SCAD in this population include structural alterations in the arterial wall secondary to hormonal change, increased shear stress during labor, fragmentation of reticulin fibers, loosening of ground substance, and hypertrophy of smooth muscle.[16]

Race

SCAD has been reported in all major racial and ethnic groups, with the majority of patients being white. This finding may have been influenced by referral and sampling bias as well as the demography of patients from the reporting hospitals.[8][17][18]

References

  1. ↑ 1.0 1.1 Hayes, Sharonne N.; Kim, Esther S.H.; Saw, Jacqueline; Adlam, David; Arslanian-Engoren, Cynthia; Economy, Katherine E.; Ganesh, Santhi K.; Gulati, Rajiv; Lindsay, Mark E.; Mieres, Jennifer H.; Naderi, Sahar; Shah, Svati; Thaler, David E.; Tweet, Marysia S.; Wood, Malissa J. (2018). "Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association". Circulation: CIR.0000000000000564. doi:10.1161/CIR.0000000000000564. ISSN 0009-7322.
  2. ↑ 2.0 2.1 2.2 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Nakashima, Takahiro; Noguchi, Teruo; Haruta, Seiichi; Yamamoto, Yusuke; Oshima, Shuichi; Nakao, Koichi; Taniguchi, Yasuyo; Yamaguchi, Junichi; Tsuchihashi, Kazufumi; Seki, Atsushi; Kawasaki, Tomohiro; Uchida, Tatsuro; Omura, Nobuhiro; Kikuchi, Migaku; Kimura, Kazuo; Ogawa, Hisao; Miyazaki, Shunichi; Yasuda, Satoshi (2016). "Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris–Myocardial Infarction Multicenter Investigators in Japan". International Journal of Cardiology. 207: 341–348. doi:10.1016/j.ijcard.2016.01.188. ISSN 0167-5273.
  7. ↑ Alfonso, F.; Bastante, T. (2014). "Spontaneous Coronary Artery Dissection: Novel Diagnostic Insights From Large Series of Patients". Circulation: Cardiovascular Interventions. 7 (5): 638–641. doi:10.1161/CIRCINTERVENTIONS.114.001984. ISSN 1941-7640.
  8. ↑ 8.0 8.1 Saw, Jacqueline; Aymong, Eve; Mancini, G.B. John; Sedlak, Tara; Starovoytov, Andrew; Ricci, Donald (2014). "Nonatherosclerotic Coronary Artery Disease in Young Women". Canadian Journal of Cardiology. 30 (7): 814–819. doi:10.1016/j.cjca.2014.01.011. ISSN 0828-282X.
  9. ↑ Rashid, Hashrul N.Z.; Wong, Dennis T.L.; Wijesekera, Harendra; Gutman, Sarah J.; Shanmugam, Vimal B.; Gulati, Rajiv; Malaipan, Yuvaraj; Meredith, Ian T.; Psaltis, Peter J. (2016). "Incidence and characterisation of spontaneous coronary artery dissection as a cause of acute coronary syndrome — A single-centre Australian experience". International Journal of Cardiology. 202: 336–338. doi:10.1016/j.ijcard.2015.09.072. ISSN 0167-5273.
  10. ↑ 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.
  11. ↑ Adlam, David; Alfonso, Fernando; Maas, Angela; Vrints, Christiaan; al-Hussaini, Abtehale; Bueno, Hector; Capranzano, Piera; Gevaert, Sofie; Hoole, Stephen P; Johnson, Tom; Lettieri, Corrado; Maeder, Micha T; Motreff, Pascal; Ong, Peter; Persu, Alexandre; Rickli, Hans; Schiele, Francois; Sheppard, Mary N; Swahn, Eva (2018). "European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection". European Heart Journal. doi:10.1093/eurheartj/ehy080. ISSN 0195-668X.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ Narasimhan, Seshasayee (2004). "Spontaneous coronary artery dissection (SCAD)". Indian Journal of Thoracic and Cardiovascular Surgery. 20 (4): 189–191. doi:10.1007/s12055-004-0084-x. ISSN 0970-9134.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ Saw, Jacqueline; Aymong, Eve; Mancini, G.B. John; Sedlak, Tara; Starovoytov, Andrew; Ricci, Donald (2014). "Nonatherosclerotic Coronary Artery Disease in Young Women". Canadian Journal of Cardiology. 30 (7): 814–819. doi:10.1016/j.cjca.2014.01.011. ISSN 0828-282X.
  18. ↑ Tweet, M. S.; Hayes, S. N.; Pitta, S. R.; Simari, R. D.; Lerman, A.; Lennon, R. J.; Gersh, B. J.; Khambatta, S.; Best, P. J. M.; Rihal, C. S.; Gulati, R. (2012). "Clinical Features, Management, and Prognosis of Spontaneous Coronary Artery Dissection". Circulation. 126 (5): 579–588. doi:10.1161/CIRCULATIONAHA.112.105718. ISSN 0009-7322.
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