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Multivessel spontaneous coronary artery dissection: Clinical features, angiographic findings, management, and
Jorge Salamanca1, Marcos García-Guimarães2, Manel Sabaté3
1Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain.
Insights
Multivessel spontaneous coronary artery dissection (SCAD) patients exhibit distinct features but similar outcomes to single-vessel SCAD. However, multivessel SCAD is associated with a significantly higher stroke rate.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Research
Background:
- Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome.
- Multivessel (MV) SCAD presents a complex clinical scenario with potentially worse outcomes than single-vessel (SV) SCAD.
Purpose of the Study:
- To compare clinical characteristics, angiographic findings, and outcomes between patients with MV SCAD and SV SCAD.
- To identify specific risk factors and clinical presentations associated with MV SCAD.
Main Methods:
- Analysis of a Spanish nationwide prospective SCAD registry including 389 patients.
- Classification of patients into MV SCAD and SV SCAD groups.
- Evaluation of in-hospital major adverse events (MAE) and long-term major adverse cardiac or cerebrovascular events (MACCE).
Main Results:
- MV SCAD occurred in 10.5% of patients, often associated with hypothyroidism and anxiety disorders.
- MV SCAD patients more frequently presented with non-ST segment elevation myocardial infarction and less frequently with type 1 angiographic lesions.
- While overall MAE and MACCE were similar, MV SCAD patients experienced a significantly higher rate of stroke, both in-hospital and at long-term follow-up.
Conclusions:
- MV SCAD has unique clinical and angiographic profiles compared to SV SCAD.
- Despite similar composite clinical outcomes, the elevated stroke risk in MV SCAD warrants specific attention and management strategies.
Background:
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Multivessel (MV) SCAD is a challenging clinical presentation that might be associated to a worse prognosis compared with patients with single-vessel (SV) involvement.
Methods:
The Spanish multicentre nationwide prospective SCAD registry included 389 consecutive patients. Patients were classified, according to the number of affected vessels, in SV or MV SCAD. Major adverse events (MAE) were analyzed during hospital stay and major cardiac or cerebrovascular adverse events (MACCE) at long-term clinical follow-up.
Results:
A total of 41 patients (10.5%) presented MV SCAD. These patients had more frequently a previous history of hypothyroidism (22% vs 11%, p = 0.04) and anxiety disorder (32% vs 16%, p = 0.01). MV SCAD patients presented more often as non-ST segment elevation myocardial infarction (73% vs 52%, p = 0.01) and showed less frequently type 1 angiographic lesions (12% vs 21%, p = 0.04). An impaired initial Thrombolysis In Myocardial Infarction (TIMI) flow 0-1 was less frequent (14% vs 29%, p < 0.01) in MV SCAD. In both groups, most patients were treated conservatively (71% vs 79%, p = NS). No differences were found regarding in-hospital MAE or MACCE at late follow-up (median 29 ± 11 months). However, the rate of stroke was higher in MV SCAD patients, both in-hospital (2.4% vs 0%, p < 0.01) and at follow-up (5.1% vs 0.6%, p = 0.01).
Conclusions:
Patients with MV SCAD have some distinctive clinical and angiographic features. Although composite clinical outcomes, in-hospital and at long-term follow-up, were similar to those seen in patients with SV SCAD, stroke rate was significantly higher in patients with MV SCAD.
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