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Revascularization and long-term outcomes in high-acuity spontaneous coronary artery dissection
Christina Thaler1, Dawn R Witt1, Timothy D Henry2
1Penny Anderson Women's Cardiovascular Center at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Insights
Spontaneous coronary artery dissection (SCAD) often requires conservative treatment. However, high-acuity SCAD patients undergoing revascularization showed favorable long-term survival, despite initial risks.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Spontaneous coronary artery dissection (SCAD) is typically managed conservatively due to risks associated with revascularization procedures.
- A significant subset of SCAD patients present with high-acuity characteristics that necessitate revascularization, yet their long-term outcomes remain uncertain.
Purpose of the Study:
- To evaluate the utilization of revascularization in patients with high-acuity spontaneous coronary artery dissection.
- To assess the long-term outcomes of revascularized patients with high-acuity SCAD.
Main Methods:
- A prospective/retrospective analysis was conducted on consecutive patients experiencing acute myocardial infarction (AMI) due to SCAD.
- Data were collected from patients presenting to the Minneapolis Heart Institute between 2002 and 2021, with a median follow-up of 3.8 years.
Main Results:
- Of 139 SCAD patients (96% female), 60 (43%) underwent revascularization (PCI or CABG).
- High-acuity characteristics (e.g., ST-elevation, cardiogenic shock, left main dissection) were present in 65% of patients, driving 85% of revascularizations.
- Survival was high (97% revascularized vs. 100% non-revascularized), with comparable adverse outcomes between groups, though reintervention was needed in 21% of PCI patients.
Conclusions:
- Nearly two-thirds of the SCAD cohort exhibited high-acuity features, with most revascularizations performed in this subgroup.
- Despite the high acuity, patients who underwent revascularization demonstrated favorable long-term survival rates.
Background:
Spontaneous coronary artery dissection (SCAD) is often treated conservatively due to revascularization risks. Yet, an important number of SCAD patients have high acuity characteristics necessitating revascularization, with uncertain long-term outcomes.
Objectives:
Document revascularization utilization and long-term outcomes in high acuity SCAD.
Methods:
Prospective/retrospective analysis of consecutive patients with acute myocardial infarction (AMI) due to first SCAD event presenting directly to the Minneapolis Heart Institute 2002-2021, median follow-up 3.8 years.
Results:
Among 139 patients (age 49 ± 12 years, 96% female), revascularization was performed in 60 (43%), utilizing percutaneous coronary intervention (PCI) (n = 56, successful in 80%) or coronary artery bypass graft (n = 4). In the entire cohort, 90 (65%) unique patients had one or more high acuity characteristic: ST-elevation (38%), proximal dissection (38%), cardiogenic shock (6.5%), cardiac arrest (9.4%), left main dissection (6.5%), peripartum dissection (7.2%). High acuity patients accounted for 51 of 60 (85%) revascularizations. Revascularization rates were: ST-elevation (60%), proximal dissection (62%), cardiogenic shock (89%), cardiac arrest (62%), left main dissection (100%), peripartum dissection (70%). Survival was 97% (revascularized) vs 100% (nonrevascularized); p = 0.2. Adverse outcomes (revascularized vs. nonrevascularized) included recurrent AMI:16.7% versus 8.9%; p = 0.2, SCAD recurrence: 13.3% versus 6.3%; p = 0.1, stroke: 5% versus 2.5%; p = 0.44, implantable cardioverter-defibrillator: 6.7% versus 6.3%; p > 0.9. Reintervention was necessary in 21% of PCI-treated patients.
Conclusions:
High-acuity characteristics were present in nearly two-thirds of this SCAD cohort; the vast majority of revascularizations were performed in high-acuity patients. Despite high acuity, long-term survival was favorable in revascularized patients.
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