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Spontaneous and catheter-induced secondary coronary artery dissection: a single-centre experience
Josko Bulum1, Maja Strozzi, Anton Smalcelj
1Department of Cardiology, Zagreb University Hospital Centre, Croatia. josko.bulum@zg.t-com.hr
Insights
Spontaneous coronary artery dissection (SCAD) is uncommon but significant, often presenting as myocardial infarction. Modern interventions improve survival rates for SCAD patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Spontaneous Coronary Artery Dissection (SCAD) is a rare but serious condition.
- Historically, SCAD has been associated with high mortality rates.
- The role of modern interventions in SCAD management is increasingly recognized.
Purpose of the Study:
- To analyze the incidence and outcomes of SCAD in patients undergoing coronary angiography.
- To evaluate the effectiveness of current treatment strategies for SCAD.
Main Methods:
- Retrospective analysis of 6497 consecutive patients undergoing coronary angiography over three years.
- Identification and classification of SCAD cases (spontaneous vs. iatrogenic).
- Review of clinical presentation, interventions, and patient outcomes.
Main Results:
- SCAD was identified in 8 patients (5 spontaneous, 3 iatrogenic).
- All spontaneous SCAD cases presented as myocardial infarction.
- Successful percutaneous coronary intervention (PCI) in 3 patients; urgent coronary artery bypass grafting (CABG) in 3 patients; medical management in 2 patients.
Conclusions:
- SCAD is not exceptional and its incidence may be underestimated.
- Modern interventional cardiology and surgical techniques contribute to improved survival in SCAD patients.
- Timely diagnosis and appropriate management are crucial for SCAD patient outcomes.
Abstract:
6497 consecutive patients who underwent coronary angiography in our institution in a three-year period were analysed. Spontaneous coronary artery dissection was noted in five, and unexpected dissection secondary to coronary arteriography in three patients. All patients with spontaneous dissection presented clinically as myocardial infarction. Three patients (two of them with spontaneous dissection) underwent urgent coronary artery bypass grafting. Percutaneous coronary intervention was successful in two patients with spontaneous and in one with unexpected secondary dissection. One patient with spontaneous and one with secondary dissection were treated medically after failed intervention. In conclusion, spontaneous coronary artery dissection is rare, but not exceptional. Its true incidence might have been underestimated before the advent of coronary interventions in acute myocardial infarction. Survival of all our patients, in contrast to earlier reports on mortality rates up to 50%, may be attributed to the benefits of modern surgery and interventional cardiology.
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