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Primary Percutaneous Coronary Intervention in Patients With Spontaneous Coronary Artery Dissection vs Coronary Artery

Fernando Alfonso1, Cristina Fernández-Pérez2, Náyade Del Prado3

  • 1Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, Madrid, Spain.

JACC. Cardiovascular Interventions
|August 17, 2023
PubMed

Insights

Primary percutaneous coronary intervention (PPCI) for spontaneous coronary artery dissection (SCAD) with ST-segment elevation myocardial infarction (STEMI) shows similar outcomes to non-SCAD STEMI. This supports PPCI

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Myocardial Infarction

Background:

  • Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI).
  • Revascularization in SCAD is challenging and not recommended initially for stable SCAD without high-risk features.

Purpose of the Study:

  • To compare in-hospital mortality and 30-day readmission rates.
  • To evaluate outcomes of primary percutaneous coronary intervention (PPCI) in SCAD patients with ST-segment elevation myocardial infarction (STEMI) versus non-SCAD STEMI patients.

Main Methods:

  • Study utilized the Spanish National Health System administrative dataset (2016-2020).
  • Calculated risk-standardized in-hospital mortality and readmission ratios.
  • Propensity score (PS) analyses adjusted for confounding factors.

Main Results:

  • Identified 65,957 PPCI episodes; 315 (0.5%) were SCAD.
  • SCAD PPCI patients were younger and predominantly female.
  • In-hospital mortality (5.7% vs 4.8%) and 30-day readmission rates (3% vs 4%) were similar between SCAD PPCI and non-SCAD PPCI groups, even after PS adjustment.

Conclusions:

  • PPCI in selected STEMI patients with SCAD demonstrates comparable in-hospital mortality and 30-day readmission rates to atherothrombotic STEMI.
  • These findings support the utility of PPCI in specific SCAD cases.
Abstract

Keywords:
acute coronary syndromeacute myocardial infarctionangiographycomplicationscoronary revascularizationdiagnosismortalityreadmissionspontaneous coronary artery dissection

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