Spontaneous coronary artery dissection: revascularization versus conservative therapy
Marysia S Tweet1, Mackram F Eleid1, Patricia J M Best1
1From the Divisions of Cardiovascular Diseases (M.S.T., M.F.E., P.J.M.B., A.L., C.S.R., D.R.H., S.N.H., R.G.) and Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic, Rochester, MN.
Circulation. Cardiovascular Interventions
|November 20, 2014
Summary
Optimal management for spontaneous coronary artery dissection (SCAD) is unclear. Percutaneous coronary intervention (PCI) showed high failure rates and no benefit over conservative therapy for SCAD patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Acute Coronary Syndromes
Background:
- Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of acute coronary syndrome.
- Optimal management strategies for SCAD remain undefined in clinical practice.
Purpose of the Study:
- To compare outcomes of revascularization versus conservative therapy for SCAD.
- To evaluate percutaneous coronary intervention (PCI) versus conservative therapy, stratified by initial vessel flow.
Main Methods:
- Retrospective study of 189 patients with a first SCAD episode.
- Comparison of management strategies: revascularization vs. conservative, and PCI vs. conservative.
- Analysis of procedural failure, in-hospital course, and long-term outcomes including target vessel revascularization and recurrent SCAD.
Main Results:
- PCI failure rate was 53%, and 50% in patients with preserved vessel flow, with 13% requiring emergency bypass grafting.
- Conservative management resulted in an uneventful in-hospital course for 90% of patients, with 10% requiring later revascularization.
- No significant difference in 5-year rates of target vessel revascularization (30% vs. 19%) or recurrent SCAD (23% vs. 31%) between revascularization and conservative groups.
Conclusions:
- Percutaneous coronary intervention (PCI) for SCAD is linked to high technical failure rates, even with preserved vessel flow.
- PCI does not reduce rates of target vessel revascularization or recurrent SCAD compared to conservative management.
- Conservative management with extended observation may be a preferred strategy for SCAD.
Keywords:
acute coronary syndromecoronary artery dissection, spontaneouspercutaneous coronary interventionsMore Related Videos
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