Canadian Spontaneous Coronary Artery Dissection Cohort Study 3-Year Outcomes

被引：79

作者：

Saw, Jacqueline ^{[1
]}

Starovoytov, Andrew ^{[1
]}

Aymong, Eve ^{[2
]}

Inohara, Taku ^{[1
]}

Alfadhel, Mesfer ^{[1
]}

McAlister, Cameron ^{[1
]}

Samuel, Rohit ^{[1
]}

Grewal, Tejana ^{[1
]}

Parolis, Johandra Argote ^{[1
]}

Sheth, Tej ^{[3
]}

So, Derek ^{[4
]}

Minhas, Kunal ^{[5
]}

Brass, Neil ^{[6
]}

Lavoie, Andrea ^{[7
,8
]}

Bishop, Helen ^{[9
]}

Lavi, Shahar ^{[10
]}

Pearce, Colin ^{[11
]}

Renner, Suzanne ^{[12
]}

Madan, Mina ^{[13
]}

Welsh, Robert C. ^{[14
]}

McGrath, Brent M. ^{[15
]}

Vijayaraghavan, Ram ^{[16
]}

Har, Bryan ^{[17
]}

Ibrahim, Reda ^{[18
]}

Chaudhary, Pulkit ^{[19
]}

Ganesh, Santhi K. ^{[20
]}

Graham, John ^{[21
]}

Matteau, Alexis ^{[22
]}

Martucci, Giuseppe ^{[23
]}

Ko, Dennis T. ^{[13
]}

Humphries, Karin ^{[24
]}

Mancini, G. B. John ^{[1
]}

机构：

[1] Vancouver Gen Hosp, Div Cardiol, Vancouver, BC, Canada

[2] St Pauls Hosp, Div Cardiol, Vancouver, BC, Canada

[3] Hamilton Gen Hosp, Div Cardiol, Hamilton, ON, Canada

[4] Univ Ottawa, Inst Heart, Ottawa, ON, Canada

[5] St Boniface Gen Hosp, Winnipeg, MB, Canada

[6] Royal Alexandra Hosp, Edmonton, AB, Canada

[7] Univ Saskatchewan, Regina, SK, Canada

[8] Prairie Vasc, Regina, SK, Canada

[9] Queen Elizabeth 2 Hlth Sci Ctr, Halifax, NS, Canada

[10] London Hlth Sci Ctr, London, ON, Canada

[11] Royal Univ Hosp, Saskatoon, SK, Canada

[12] St Marys Gen Hosp, Kitchener, ON, Canada

[13] Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[14] Univ Alberta, Edmonton, AB, Canada

[15] New Brunswick Heart Ctr, St John, NB, Canada

[16] Scarborough Cardiol Res, Scarborough, ON, Canada

[17] Foothills Prov Gen Hosp, Calgary, AB, Canada

[18] Montreal Heart Inst, Montreal, PQ, Canada

[19] Cleveland Clin Fdn, Cleveland, OH USA

[20] Univ Michigan, Ann Arbor, MI USA

[21] St Michaels Hosp, Toronto, ON, Canada

[22] Ctr Hosp Univ Montreal, Montreal, PQ, Canada

[23] McGill Univ, Ctr Hlth, Montreal, PQ, Canada

[24] BC Ctr Improved Cardiovasc Hlth, Vancouver, BC, Canada

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2022年 / 80卷 / 17期

基金：

美国国家卫生研究院; 加拿大健康研究院;

关键词：

spontaneous coronary artery dissection; women; ACUTE MYOCARDIAL-INFARCTION; FIBROMUSCULAR DYSPLASIA; ASSOCIATION; PREVALENCE;

D O I：

10.1016/j.jacc.2022.08.759

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in young to middle-aged women. OBJECTIVES We aim to define the long-term natural history of SCAD. METHODS We performed a multicenter, prospective, observational study of patients with nonatherosclerotic SCAD presenting acutely from 22 North American centers. We recorded baseline demographics, in-hospital characteristics, precipitating and predisposing conditions, angiographic features (adjudicated), in-hospital and 3-year major adverse cardiovascular events (MACE). Cox regression multivariable analysis was performed. RESULTS We prospectively enrolled 750 consecutive patients with SCAD from June 2014 to June 2018. Mean age was 51.7 similar to 10.5 years, 88.5% were women (55.0% postmenopausal); 31.3% presented with ST-segment elevation myocardial infarction, and 68.3% with non-ST-segment elevation myocardial infarction. Precipitating emotional stressor was reported in 50.3%, and physical stressor in 28.9%. Predisposing conditions included fibromuscular dysplasia in 42.9% (56.4% in those with complete screening), peripartum state 4.5%, and genetic disorders 1.6%. Most patients were treated conservatively (84.3%); 14.1% underwent percutaneous coronary intervention (PCI), 0.7% coronary artery bypass graft. At 3.0-year median follow-up, mortality was 0.8%, recurrent MI 9.9% (extension of previous SCAD 3.5%, de novo recurrent SCAD 2.4%, iatrogenic dissection 1.9%), with overall MACE 14.0%. Presence of genetic disorders, peripartum SCAD, and extracoronary fibromuscular dysplasia were independent predictors of 3-year MACE. Patients who underwent PCI at index hospitalization had similar postdischarge MACE compared with no PCI. At 3 years, 80.0% remained on aspirin and 73.5% on beta-blockade. CONCLUSIONS Long-term mortality and de novo recurrent SCAD was low in our contemporary large SCAD cohort that included low revascularization rate and high use of beta-blockade and aspirin. Genetic disorders, extracoronary fibromuscular dysplasia, and peripartum SCAD were independent predictors of long-term MACE. (J Am Coll Cardiol 2022;80:1585-1597) (c) 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation.

引用

页码：1585 / 1597

页数：13

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