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Published on: June 12, 2021
Spontaneous Coronary Artery Dissection with Cardiogenic Shock in the United States
Chayakrit Krittanawong1, Dhrubajyoti Bandyopadhyay2, Neelkumar Patel3
1Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA.
Insights
Spontaneous coronary artery dissection (SCAD) with cardiogenic shock significantly increases the risk of death and complications. However, 30-day readmission rates remain similar between patients with and without cardiogenic shock.
Area of Science:
- Cardiology
- Internal Medicine
- Critical Care Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) is a non-traumatic separation of coronary artery walls, presenting management challenges.
- Decisions for revascularization and medical management in SCAD are individualized.
- Cardiogenic shock (CS) is a severe complication of SCAD, necessitating outcome evaluation.
Purpose of the Study:
- To compare outcomes in patients with SCAD, focusing on the impact of cardiogenic shock.
- To analyze in-hospital mortality and 30-day readmission rates in SCAD patients with and without CS.
- To identify specific complications associated with SCAD and CS.
Main Methods:
- Utilized the Nationwide Readmissions Database (NRD) from 2016-2019.
- Evaluated demographics, risk factors, comorbidities, and in-hospital outcomes using ICD-10-CM codes.
- Compared primary outcomes (in-hospital mortality, 30-day readmission) and secondary outcomes (complications) between SCAD patients with and without CS.
Main Results:
- Analyzed 2473 SCAD patients: 274 with CS and 2199 without CS.
- SCAD with CS showed significantly increased odds of death (OR 24.93), mechanical circulatory support use (OR 15.30), ventricular tachycardia (OR 4.45), blood transfusions (OR 3.82), acute kidney injury (OR 4.02), mechanical ventilation (OR 8.87), and respiratory failure (OR 4.95).
- No significant difference in 30-day readmission rates was observed between the groups.
Conclusions:
- SCAD associated with cardiogenic shock leads to a higher likelihood of severe complications, including mortality.
- Cardiogenic shock in SCAD patients represents a critical scenario requiring comprehensive, multidisciplinary care.
- Prompt recognition and management are crucial to mitigate complications in SCAD patients with cardiogenic shock.
Background:
Spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic separation of the epicardial coronary artery walls that creates a false lumen. SCAD poses a difficult challenge in management, as decisions regarding revascularization and medical management seem to be tailored to the individual patient. We evaluated and compared outcomes based on cardiogenic shock in patients with SCAD utilizing Nationwide Readmissions Database (NRD) between January 1, 2016, to December 30, 2020.
Methods:
We utilized the NRD 2016-2019 to carry out this study. We evaluated demographics (e.g., age, gender), conventional risk factors, comorbidities present on the index admission, and in-hospital outcomes using their specific ICD-10-CM codes. The primary outcomes were In-hospital mortality and 30-day readmission, and the secondary outcome was to compare the complications in SCAD patient with cardiogenic shock (CS) compared to those without CS.
Results:
We analyzed 2473 individuals with SCAD, 2199 of these individuals did not have cardiogenic shock whereas 274 of these individuals did have cardiogenic shock. When comparing SCAD with cardiogenic shock to SCAD without cardiogenic shock, there was a statistically significant increased odds ratio (OR) for death (propensity matched OR 24.93 (7.49-83.05), use of mechanical circulatory support (propensity matched OR 15.30 (6.87-34.04), ventricular tachycardia (propensity matched OR 4.45 (1.92-10.34), utilization of blood transfusions (propensity matched OR 3.82 (1.86-7.87), acute kidney injury (propensity matched OR 4.02 (1.45-11.13), need for mechanical ventilation (propensity matched OR 8.87 (3.53-22.31), and respiratory failure (propensity matched OR 4.95 (1.83-13.41)))))))). There was no statistically significant difference in 30-day readmission rates between the two groups.
Conclusions:
SCAD is a unique condition that can lead to many complications. In our analysis, we showed that SCAD associated with cardiogenic shock compared to SCAD not associated with cardiogenic shock results in greater odds of complications including death, use of mechanical circulatory support, need for blood transfusions, ventricular tachycardia, acute kidney injury, use of mechanical ventilation, and respiratory failure. SCAD with cardiogenic shock represents a significantly critical clinical scenario that requires a multi-disciplinary approach to prevent the many potential complications associated with this disease process.
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