Spontaneous coronary artery dissection natural history, complications and prognosis

Jump to navigation Jump to search

Spontaneous Coronary Artery Dissection Microchapters

Home

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 natural history of spontaneous coronary artery dissection has not been well characterized. Early reports based on post-mortem examinations after sudden cardiac death suggest a dismal prognosis. However, recent studies demonstrate that most patients survive initial hospitalization and have a favorable prognosis following clinical stabilization.

Natural History, Complications and Prognosis

Natural History

The natural history of spontaneous coronary artery dissection (SCAD) has not been well characterized. Early reports based on post-mortem examinations and small case series suggest a dismal prognosis, with sudden cardiac death as the initial presentation in 28% of cases and an in-hospital mortality of 49%.[1] In contrast, data from recent studies demonstrate that the majority of SCAD lesions heal spontaneously over time and achieve complete resolution on repeat angiography within one month among stabilized patients who survive initial hospitalization.[2][3] The risk of recurrence has been reported in 10 to 30% of cases with a 3- to 10-year follow-up from different series that adopted a non-revascularization management approach.[2][4][5][6][7]

Complications

Complications include:

Prognosis

In the current literature, the prognosis of SCAD has been determined according to the small case series including different treatment options. Long-term survival after an index SCAD episode appears to be better compared with that of acute coronary syndrome (ACS). However, the rate of major adverse cardiac events (MACE) is comparable between post-SCAD and post-ACS settings. According to a recent cohort study, the rates of in-hospital myocardial infarction and long-term MACE were 4.5% and 20%, respectively.[10] In addition, unsuccessful percutaneous coronary intervention (PCI) was observed in approximately one-third of cases.[11] In-hospital prognosis was better in the conservative treatment group when compared with patients managed with PCI.[10][12] Another large cohort with a median follow-up of 3.1 years reported a post-discharge MACE rate of 19.9% (approximately 6 events/100 person-years), with myocardial infarction (16.8%) and recurrent SCAD (10.4%) as the most frequent events.[7] After adjusting for cardiovascular risk factors, predisposing arteriopathies, precipitating stressors, medications, and revascularization, hypertension increased the risk of SCAD recurrence by 2.5 times, whereas beta-blocker usage reduced the recurrence risk by 64%. Considering the favorable prognosis and the high failure rate of percutaneous coronary intervention in this scenario, the results support the initial conservative treatment strategy for clinically stable patients without left main artery involvement.

References

  1. ↑ Kolle, Patrick T.; Cliffe, Charles M.; Ridley, David J. (1998). "Immunosuppressive therapy for peripartum-type spontaneous coronary artery dissection: Case report and review". Clinical Cardiology. 21 (1): 40–46. doi:10.1002/clc.4960210108. ISSN 0160-9289.
  2. ↑ 2.0 2.1 Saw, J.; Aymong, E.; Sedlak, T.; Buller, C. E.; Starovoytov, A.; Ricci, D.; Robinson, S.; Vuurmans, T.; Gao, M.; Humphries, K.; Mancini, G. B. J. (2014). "Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes". Circulation: Cardiovascular Interventions. 7 (5): 645–655. doi:10.1161/CIRCINTERVENTIONS.114.001760. ISSN 1941-7640.
  3. ↑ Rogowski, Sebastian; Maeder, Micha T.; Weilenmann, Daniel; Haager, Philipp K.; Ammann, Peter; Rohner, Franziska; Joerg, Lucas; Rickli, Hans (2017). "Spontaneous Coronary Artery Dissection". Catheterization and Cardiovascular Interventions. 89 (1): 59–68. doi:10.1002/ccd.26383. ISSN 1522-1946.
  4. ↑ 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.
  5. ↑ Tweet, M. S.; Eleid, M. F.; Best, P. J. M.; Lennon, R. J.; Lerman, A.; Rihal, C. S.; Holmes, D. R.; Hayes, S. N.; Gulati, R. (2014). "Spontaneous Coronary Artery Dissection: Revascularization Versus Conservative Therapy". Circulation: Cardiovascular Interventions. 7 (6): 777–786. doi:10.1161/CIRCINTERVENTIONS.114.001659. ISSN 1941-7640.
  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. ↑ 7.0 7.1 Saw, Jacqueline; Humphries, Karin; Aymong, Eve; Sedlak, Tara; Prakash, Roshan; Starovoytov, Andrew; Mancini, G.B. John (2017). "Spontaneous Coronary Artery Dissection". Journal of the American College of Cardiology. 70 (9): 1148–1158. doi:10.1016/j.jacc.2017.06.053. ISSN 0735-1097.
  8. ↑ Prakash, Roshan; Starovoytov, Andrew; Heydari, Milad; Mancini, G.B. John; Saw, Jacqueline (2016). "Catheter-Induced Iatrogenic Coronary Artery Dissection in Patients With Spontaneous Coronary Artery Dissection". JACC: Cardiovascular Interventions. 9 (17): 1851–1853. doi:10.1016/j.jcin.2016.06.026. ISSN 1936-8798.
  9. ↑ Hany Awadalla, Sameh Sabet, Ashraf El Sebaie, Oscar Rosales & Richard Smalling (2005). "Catheter-induced left main dissection incidence, predisposition and therapeutic strategies experience from two sides of the hemisphere". The Journal of invasive cardiology. 17 (4): 233–236. PMID 15831980. Unknown parameter |month= ignored (help)
  10. ↑ 10.0 10.1 Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D; et al. (2014). "Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes". Circ Cardiovasc Interv. 7 (5): 645–55. doi:10.1161/CIRCINTERVENTIONS.114.001760. PMID 25294399.
  11. ↑ Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS; et al. (2014). "Spontaneous coronary artery dissection: revascularization versus conservative therapy". Circ Cardiovasc Interv. 7 (6): 777–86. doi:10.1161/CIRCINTERVENTIONS.114.001659. PMID 25406203.
  12. ↑ Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ; et al. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.
Retrieved from "https://www.wikidoc.org/index.php?title=Spontaneous_coronary_artery_dissection_natural_history,_complications_and_prognosis&oldid=1448517"