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Treatment strategy for spontaneous coronary artery dissection based on anatomical characteristics
Yuanji Ma1,2,3, Xin Zhong1,2,3, Jiasheng Yin1,2,3
1Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai, 200032, China.
Insights
Conservative management is recommended for low-risk spontaneous coronary artery dissection (SCAD) patients. Percutaneous coronary intervention (PCI) may be considered for high-risk SCAD, with lesion anatomy guiding treatment decisions for optimal outcomes.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome, particularly in young women.
- The optimal treatment strategy for SCAD, especially regarding percutaneous coronary intervention (PCI), remains unclear.
Purpose of the Study:
- To compare clinical and angiographic features of high-risk versus low-risk SCAD patients.
- To evaluate treatment strategies and outcomes in SCAD patients based on risk stratification.
Main Methods:
- Retrospective analysis of 81 SCAD patients (2012-2020).
- Categorization into high-risk (left main/proximal artery involvement) and low-risk groups.
- Comparison of treatment approaches (PCI vs. conservative) and 1-year clinical outcomes, including follow-up angiography for vessel healing.
Main Results:
- High-risk patients more frequently received PCI (68.4%) compared to conservative treatment (37.2%).
- Low-risk patients more commonly received conservative management (62.8%) versus PCI (31.6%).
- Major adverse cardiac events were similar between groups; however, spontaneous vessel healing was significantly higher in low-risk patients undergoing conservative treatment (86.4%) versus high-risk patients (33.3%).
Conclusions:
- Conservative management is the preferred strategy for low-risk SCAD.
- PCI can be considered for high-risk SCAD patients, with lesion anatomy being a key factor in treatment decisions.
- Favorable clinical outcomes and vessel healing support PCI in select high-risk SCAD cases.
Objectives:
To compare the clinical and angiographic characteristics of high-risk and low-risk spontaneous coronary artery dissection (SCAD) patients to determine the optimal treatment strategy.
Background:
SCAD is a rare and emerging cause of acute coronary syndrome and sudden cardiac death, especially in young female patients. However, the indication of percutaneous coronary intervention (PCI) in patients with SCAD remains elusive.
Methods:
We evaluated the clinical and angiographic characteristics of all SCAD patients admitted to our center from 2012 to 2020. The outcomes of the high-risk and low-risk SCAD patients according to the location of the lesion segment with dissection or intramural hematoma were compared. Further analyses were performed to evaluate the vessel healing or residual dissection in the patients receiving the follow-up angiography.
Results:
A total of 81 SCAD patients were enrolled in the present study, in which 38 patients were categorized as high-risk group, defined as involvement of the left main artery or proximal segment of any main coronary artery. PCI was the more common treatment approach in the high-risk group (68.4%), while conservative treatment was more common in the low-risk group (62.8%). The incidence of major adverse cardiac events, defined as cardiac death, myocardial infarction, unstable angina pectoris, severe arrhythmias, or heat failure, within 1 year follow-up was similar between the two groups. 57 patients (70.4%) received the follow-up angiography after 1 year. The high- and low-risk groups had a similar rate of vessel healing among the PCI treatment patients. However, more patients achieved spontaneous healing in the low-risk group than the high-risk group among the conservative treatment patients (86.4% vs. 33.3%, p < 0.05).
Conclusions:
Conservative management remains the recommended treatment strategy for the low-risk SCAD patients. PCI could be considered in high-risk SCAD patients with favorable clinical outcomes and vessel healing. Characterization of lesion anatomy may be an important indicator for treatment decision.
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