ABSTRACT
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an important but under-recognised cause of acute coronary syndrome (ACS), particularly in younger women. We assessed trends in the detection, management and outcomes of all patients with SCAD over 6 consecutive years. METHODS: All patients with first diagnosis of SCAD at Christchurch Public Hospital, New Zealand, between January 2014 and January 2020 were included. Patient management and outcomes were determined by retrospective review of medical records. SCAD presentations were compared to total ACS presentations, obtained from a national ACS (ANZACS-QI) database. RESULTS: We identified 113 patients with angiographic diagnosis of SCAD. Median age was 54 years (88% female). The detection of SCAD increased over the period, both as a total number (Kendall's τ 0.87, p=0.015) and as a proportion of all ACS (p value for trend <0.0001). In 2019, SCAD represented 2.4% of all ACS and 18% of ACS in females aged less than 60 years. The most common presentation was non-ST elevation myocardial infarction (NSTEMI) in 72%; and, there was an increase in NSTEMI compared with STEMI over the period (p=0.023). Initial strategy of percutaneous coronary intervention (PCI) was undertaken in 12% of patients, with a significant trend towards a more conservative approach over the study period (p=0.019). The rate of 30-day major adverse cardiovascular events (MACE) was 8.8% overall, and significantly reduced over the study period to 3% in 2019 (p value for trend, 0.006). CONCLUSIONS: The detection of SCAD has increased and is a particularly important cause of ACS in younger women. This increase has been largely driven by an increasing number of NSTEMI patients diagnosed with SCAD, associated with a significant improvement in 30-day MACE.
Subject(s)
Coronary Vessel Anomalies/surgery , Coronary Vessels/surgery , Percutaneous Coronary Intervention/methods , Vascular Diseases/congenital , Aged , Coronary Angiography , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/epidemiology , Coronary Vessels/diagnostic imaging , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , New Zealand/epidemiology , Retrospective Studies , Risk Factors , Survival Rate/trends , Time Factors , Vascular Diseases/diagnosis , Vascular Diseases/epidemiology , Vascular Diseases/surgeryABSTRACT
A case of emergency stent deployment to a critical vein graft lesion in a patient with an acute myocardial infarction and cardiogenic shock is described. An Angioguard vascular protection device was used, retrieving a large amount of atheromatous debris. Use of filter-type protection devices to prevent distal atheroembolism may be lifesaving in such patients.
