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Thrombolysis in Spontaneous Coronary Artery Dissection-Angiographic Findings and Clinical Outcomes
Cameron McAlister1, Mehima Kang1, Mesfer Alfadhel1
1Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Insights
Intravenous thrombolysis (IVT) for ST-elevation myocardial infarction (STEMI) caused by spontaneous coronary artery dissection (SCAD) showed no significant difference in major adverse cardiovascular events. This suggests IVT is a safe treatment option for SCAD STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) is a significant cause of ST-elevation myocardial infarction (STEMI), particularly in young women.
- Intravenous thrombolysis (IVT) is a standard STEMI treatment when primary percutaneous coronary intervention (PCI) is unavailable.
- Data on IVT safety in SCAD patients is limited.
Purpose of the Study:
- To evaluate the safety and effectiveness of IVT in SCAD patients presenting with STEMI.
- To compare cardiovascular outcomes between SCAD STEMI patients who received IVT and those who did not.
Main Methods:
- Analysis of demographics, angiographic findings, and outcomes from the Canadian SCAD Study.
- Comparison of SCAD STEMI patients who received IVT versus those who did not.
- Assessment of major adverse cardiovascular events (MACE), including death, cardiac arrest, heart failure, MI, stroke/TIA, and unplanned revascularization.
Main Results:
- Of 351 SCAD STEMI patients, 64 (18.2%) received IVT.
- No significant demographic differences were observed between IVT and non-IVT groups.
- No significant differences in in-hospital or long-term MACE rates were found between the groups, although a trend towards lower MACE in the IVT group was noted during follow-up (p=0.054).
Conclusions:
- SCAD STEMI patients treated with IVT had a higher proportion of angiographic type 1 SCAD.
- IVT administration in SCAD STEMI patients did not result in statistically significant differences in cardiovascular outcomes.
- IVT appears to be a safe treatment option for SCAD STEMI patients, with no increased risk of adverse events.
Background:
Intravenous thrombolysis (IVT) is an established treatment of ST-elevation myocardial infarction (STEMI) in absence of primary percutaneous coronary intervention (PCI). Spontaneous coronary artery dissection (SCAD) is an important cause of STEMI, particularly in younger women. There is a paucity of data regarding the safety of IVT in SCAD.
Methods:
We analyzed demographics, angiographic findings and cardiovascular outcomes of all STEMI patients in the Canadian SCAD Study, comparing SCAD patients receiving IVT to those who did not. Major adverse cardiovascular events (MACE) were the composite of all-cause death, cardiac arrest, heart failure, MI, stroke or transient ischemic attack (TIA), and unplanned revascularization.
Results:
Of 351 SCAD STEMI patients, 64 (18.2%) received IVT prior to angiography. There were no differences in demographics, including age (52.8±9.7 vs. 50.2±11.1 years, p=0.080) and female sex (92.2% vs. 90.9%, p=1.000). There was a greater proportion of angiographic type 1 SCAD in IVT patients (65.3% vs. 23.9%, p<0.001). There was no difference in PCI (23.4% vs. 28.2%, p=0.535), haemodynamic support (4.7% vs. 6.3%, p=1.000) or reduced left ventricular ejection fraction (<50%; 37.5% vs. 41.5%, p=0.576). During index admission, there was no significant difference in recurrent MI (3.1% vs. 7.7%, p=0.275), unplanned revascularization (1.6% vs. 5.6%, p=0.330), stroke or TIA (3.1% vs. 2.1%, p=0.624), death (0.0% vs. 0.7%, p>0.99) or MACE (6.3% vs. 11.5%, p=0.926) between IVT vs. non-IVT group. During median 3.2 years follow-up, there was numerically lower but not statistically different MACE rates (4.8% IVT vs. 13.9% non-IVT, p=0.054).
Conclusion:
SCAD STEMI patients receiving IVT had greater proportion of angiographic type 1 SCAD but no statistical difference in cardiovascular outcome.
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