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Nonatherosclerotic coronary artery disease in young women
Jacqueline Saw1, Eve Aymong1, G B John Mancini1
1Vancouver General Hospital, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Nonatherosclerotic coronary artery disease (NACAD) is common in young women, causing 30% of heart attacks. Spontaneous coronary artery dissection (SCAD) is the most frequent type of NACAD, responsible for 24% of these events.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Nonatherosclerotic coronary artery disease (NACAD) is a significant cause of myocardial infarction (MI) in young women.
- NACAD is frequently overlooked on coronary angiography, particularly spontaneous coronary artery dissection (SCAD).
- The prevalence of NACAD in this demographic remains undescribed.
Purpose of the Study:
- To determine the prevalence of NACAD in women aged 50 years and younger undergoing coronary angiography.
- To identify the specific types and frequencies of NACAD in this population.
- To assess the contribution of NACAD and SCAD to myocardial infarction in young women.
Main Methods:
- Retrospective review of coronary angiograms from women aged 50 or younger at Vancouver General Hospital (December 2009 - November 2011).
- Angiograms were assessed by two interventional cardiologists for normal arteries, atherosclerotic coronary artery disease (ACAD), or NACAD.
- NACAD was further classified into SCAD, fibromuscular dysplasia (FMD), ectasia, vasculitis, embolism, congenital anomaly, or unclear etiology.
Main Results:
- Of 177 women (mean age 45.4 years), 13.0% had NACAD and 30.5% had ACAD.
- Among NACAD cases, SCAD was most common (16 cases), followed by coronary ectasia (5 cases) and suspected vasculitis (2 cases).
- NACAD accounted for 30.3% of MIs in this cohort, with SCAD being the cause in 24.2% of MIs.
Conclusions:
- NACAD is a prevalent condition in young women undergoing coronary angiography, contributing significantly to myocardial infarction.
- Spontaneous coronary artery dissection (SCAD) is the predominant form of NACAD in young women presenting with MI.
- These findings highlight the importance of considering NACAD, especially SCAD, in the diagnosis of MI in younger women.
Background:
Nonatherosclerotic coronary artery disease (NACAD) is an important cause of myocardial infarction (MI) in young women but is often missed on coronary angiography, especially spontaneous coronary artery dissection (SCAD). The prevalence of NACAD in young women has not been described.
Methods:
We retrospectively reviewed all coronary angiograms of women aged 50 years and younger at Vancouver General Hospital from December 1, 2009 to November 30, 2011. The angiograms were reviewed by 2 experienced interventional cardiologists, and reported as normal (<30% stenosis), atherosclerotic coronary artery disease (ACAD), or NACAD. NACAD was further characterized as SCAD, coronary fibromuscular dysplasia (FMD), ectasia, vasculitis, embolism, congenital anomaly, or unclear etiology.
Results:
Of 7605 coronary angiograms performed, 177 were done in women aged 50 years and younger. The mean age was 45.4 ± 4.9 (range, 31-50) years, 76 of 177 (42.9%) presented with acute coronary syndrome, and 66 were troponin-positive. Ninety-seven (54.8%) women had normal arteries, 54 (30.5%) had ACAD, 23 (13.0%) had NACAD, and 3 (1.7%) had unclear etiology. Of those with NACAD, SCAD was observed in 16 (all troponin-positive and 13 of 16 had noncoronary FMD), and 2 had irregular beading suspicious of coronary FMD. Coronary vasculitis was suspected in 2, and 5 had coronary ectasia. Among women with MI (66/177), 19 (28.8%) had normal arteries (3 Takotsubo cardiomyopathy), 24 (36.4%) had ACAD, 20 (30.3%) had NACAD, 16 (24.2%) had SCAD, and 3 had unclear etiology.
Conclusions:
NACAD was not rare among young women (aged 50 years and younger) undergoing coronary angiography and was an important cause of MI, accounting for 30%. SCAD was the most commonly encountered NACAD in young women, causing 24% of MIs.
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