Cause Of Acute Coronary Syndrome Research Articles

Spontaneous Coronary Artery Dissection with Iliac Artery Dissection: A Case Report and Literature Review

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome or sudden cardiac death. It often occurs in females with no conventional cardiovascular risk factors. Bilateral iliac artery dissection is also a rare disease. This case report describes a patient with spontaneous coronary artery dissection and iliac artery dissection. The authors believe that a conservative approach could be used as an effective therapy for a clinically stable patient.

Sudden cardiac arrest as a result of anterior and lateral myocardial infarction at 16 weeks of gestation - case report

Sudden cardiac arrest (SCA) is defined as a significant impairment of the mechanical function of the heart muscle, characterized by the patient's lack of response to stimuli, no perceptible pulse and apnea or agonal breathing, most often caused by acute coronary syndrome (ACS). ACS during pregnancy is a rare phenomenon and its incidence increases with the age of giving birth.The most common cause of ACS in pregnancy are typical changes in the etiology of atherosclerosis or coronary artery thrombosis. Other factors increasing the risk of a heart attack are arterial hypertension, diabetes, obesity and lipid disorders. To describe a rare clinical case and demonstrate the importance of maintaining cardiac vigilance in pregnant patients. A 32-year-old patient, at 16 weeks of gestation, hospitalized due to an anterior and lateral ST Elevation Myocardial Infarction (STEMI), complicated by SCA due to the mechanism of ventricular fibrillation. The patient was qualified for invasive reperfusion treatment which included left anterior descending (LAD) coronary artery surgery with drug eluting stent (DES) implantation and ballooning of the diagonal first coronary artery. Echocardiography done after treatment revealed apical hypokinesia and left ventricular ejection fraction of 70%. Subsequently the patient was kept under obstetrical and cardiological care. At 37 weeks of gestation, the pregnancy was finished by a successful caesarean section. Pregnancy is a state of hypercoagulability and decreased activity of the fibrinolytic system.The clinical management in this case does not differ from the clinical procedure adopted for non-pregnant women. It is important to make a diagnosis quickly and implement a life-saving procedure as soon as possible.

Systematic review and meta-analysis of the clinical characteristics and outcomes of spontanous coronary artery dissection

BackgroundSpontaneous coronary artery dissection (SCAD) is an uncommon, non-iatrogenic, non-atherosclerotic cause of acute coronary syndrome. A lack of large prospective cohort studies and randomised controlled trials means that important questions about clinical characteristics and outcomes of patients with SCAD are yet to be fully answered. MethodA literature search of PUBMED, EMBASE and SCOPUS was undertaken up to and including the 23rd January 2020. Studies reporting any cohort of 10 or more SCAD patients presenting with acute coronary syndrome, with appropriate clinical follow-up data were included in the analysis. Incidences of major adverse cardiovascular events (MACE), myocardial infarction and SCAD recurrence were meta-analysed using Poisson regression. Results19 studies, totalling p=2,172 patients, were included in the analysis. There was significant heterogeneity across the studies in all baseline characteristics and clinical outcomes. Prevalence of traditional cardiovascular risk factors was low; however, hypertension had a prevalence of 45% (95% CI; [35-54]) and fibromuscular dysplasia (FMD) was present in 68% (95% CI; [61-74]). Across all cohorts, the incidence of MACE in patients with SCAD was 7.80 per 100 person years (n=19, p=2172, 95% CI; [4.50-13.54]) and SCAD recurrence was 5.49 per 100 person years (n=13, p=1408, 95% CI; [3.75-8.02]). ConclusionsThis meta-analysis confirms that SCAD is not an inconsequential cause of acute coronary syndrome and heralds the need for further prospective research to identify predictors of recurrent events and therapies to prevent them.

Role of Computed Tomography Angiography in Setting of Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome, predominantly affecting young women. Catheter-based coronary angiography is the gold standard diagnostic test, especially when coupled with intracoronary imaging. Conservative management in stable patients is the preferred approach given the increased risk of complications associated with percutaneous interventions. Noninvasive coronary computed tomography angiography (CTA) has a potential role in the diagnosis and follow-up of SCAD. CTA also plays a role in screening for extracoronary vascular abnormalities frequently associated with SCAD. The goal of this article is to review the potential role of CTA in evaluating SCAD.

Multivessel spontaneous coronary artery dissection with simultaneously three different angiographic patterns

Spontaneous coronary artery dissection (SCAD) is a non-traumatic non-iatrogenic coronary dissection. It's a frequent cause of acute coronary syndrome (ACS) in women without or with few traditional cardiovascular risk factors. We report an unusual case of multivessel SCAD in a middle-aged woman with successful medical management.

Spontaneous Coronary Artery Dissection: A Comprehensive Overview

Spontaneous coronary artery dissection is an underdiagnosed cause of acute coronary syndrome that primarily impacts young women. Spontaneous coronary artery dissection as a cause of acute coronary syndrome is not rare and should not be overlooked. Spontaneous coronary artery dissection should be considered on the list of differential diagnosis of any chest pain occurring in young women with few typical risk factors. The purposes of this article are to broaden the understanding and increase awareness of spontaneous coronary artery dissection, specifically its diagnosis and clinical outcomes.

Rol del ultrasonido intravascular en el diagnóstico de la disección coronaria espontánea

The diagnosis of spontaneous coronary artery dissection as a cause of acute coronary syndrome has increased since the arise of intravascular imaging techniques. However, it still remains an underdiagnosed entity. Evidence related to its management is scarce, but conservative strategies have shown favorable outcomes in selected patients. We present the case of a 55-year-old female patient who is diagnosed with a non-ST segment elevation myocardial infarction. Spontaneous coronary artery dissection is suspected in the coronary angiography and then confirmed by intravascular ultrasound. Conservative management was selected, with favorable clinical outcomes.

Clinical characteristics and treatment of Spontaneous Coronary Artery Dissection in Young Women Undergoing Percutaneous Coronary Intervention.

Spontaneous coronary artery dissection (SCAD) has recently been recognized as a cause of acute coronary syndrome (ACS), especially in young women. However, the characteristics, optimal treatment, and prognosis of patients who experience SCAD have not been fully described. Data were retrospectively collected from a multicenter registry. Among 187 young women less than 60 years of age who underwent percutaneous coronary intervention, 19 (10.2%) with SCAD were identified through coronary angiography. Clinical characteristics and outcomes were investigated. Those with SCAD less frequently exhibited coronary risk factors, such as diabetes, dyslipidemia, and smoking, than those without SCAD. Intense emotional and/or physical stress was more frequently observed as a prominent precipitating factor in cases of SCAD. All 19 SCAD patients presented with ACS, 7 of whom were treated using stents, and the other 12 treated without stents. During a median follow-up of 960 days (interquartile range, 686-1504 days), two recurrent coronary artery dissections occurred within 7 days, both of which occurred in a vessel other than that in which primary dissection occurred. There were no deaths or recurrent dissection after 1 week. SCAD was not uncommon among young Japanese women requiring percutaneous coronary intervention. Patients with SCAD exhibited fewer coronary risk factors and more precipitating factors than those without SCAD, and long-term clinical outcomes after an early period appeared to be favorable.

Clinical Presentation and Outcome of Patients With Spontaneous Coronary Artery Dissection Versus Atherosclerotic Coronary Plaque Dissection.

Atherosclerotic coronary plaque dissection (ACPD) is one cause of acute coronary syndrome (ACS) caused by underlying atherosclerosis. Spontaneous coronary artery dissection (SCAD) occurs outside the setting of atherosclerosis among young women and individuals with few or no conventional atherosclerotic risk factors, and has emerged as an important cause of ACS, and sudden death. A comparison between ACPD and SCAD has not been previously addressed in the literature. Our study will compare ACPD and SCAD. Patients with confirmed diagnosis of SCAD and ACPD were retrospectively identified from 30 centers in 4 Arab Gulf countries between January 2011 and December 2017. In-hospital (ventricular tachycardia/ventricular fibrillation, myocardial infarction (MI), percutaneous coronary intervention, dissection extension, cardiogenic shock, death, implantable cardioverter-defibrillator placement) and follow-up (MI, de novo SCAD, spontaneous superior mesenteric artery dissection, death) events were compared between them. Eighty-three cases of SCAD and 48 ACPD were compared. ACPD patients were more frequently male (91.67% vs. 49.40%, P < 0.001) and older (58.5 vs. 44, P < 0.001). Cardiovascular risk factors were more prevalent in patients with ACPD, including diabetes mellitus (60.4% vs. 25.3%), dyslipidemia (62.5% vs. 38.5%), and hypertension (62.5% vs. 31.3%), P < 0.001. Hospital presentation of ST-elevation MI was diagnosed in 48% of SCAD versus 27% of ACPD patients (P = 0.012). SCAD patients received medical-only treatment in 40% of cases and ACPD in 21% (P = 0.042). In-hospital and follow-up events were comparable in both groups (P = 0.25). Despite a completely different pathophysiology of ACS between SCAD and ACPD, in-hospital and follow-up events were comparable.

SPONTANEOUS CORONARY ARTERY DISSECTION IN A MALE WITH ISCHEMIC STROKE: A CASE REPORT WITH BRIEF REVIEW OF LITERATURE

Spontaneous coronary artery dissection (SCAD), also referred to as SCAD, is an uncommon emergency condition that occurs when a tear forms in a blood vessel in the heart. SCAD has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden cardiac death, particularly among individuals with few conventional atherosclerotic risk factors and young women. It is usually seen in females with pre-existing conditions such as connective tissue disease, systemic lupus erythematosus, and the puerperium. Commonly, the patient presents with acute-onset severe chest pain coupled with autonomic symptoms such as diaphoresis, palpitations, and hypotension. SCAD presenting with ischemic stroke in a male patient is extremely rare. Hereby, we present a case of SCAD in a middle-aged gentleman who strangely presented with ischemic stroke.

Frequency of risk factors in patients of acute coronary syndrome due to coronary ectasia.

Coronary artery ectasia is a relatively common entity characterized by inappropriate dilatation of the coronary vasculature. In some cases of acute coronary syndrome without obstructive coronary lesions, coronary ectasia is the sole cause. The exact mechanism of its development is unknown but evidence suggests a combination of genetic predisposition, common risk factors for coronary artery disease, and abnormal vessel wall metabolism. As there are few data regarding the pattern of coronary risk factors in patients with coronary ectasia, the objective of the study was to determine the frequency and distribution of coronary risk factors in patients with acute coronary syndrome solely due to coronary ectasia. The study included 155 patients over a period of 6 months, with coronary angiographic evidence of coronary ectasia as the sole cause of acute coronary syndrome. There were 79 (51%) men and 76 (49%) women with a mean age 51.92 ± 7.83 years; 73 (47.10%) were aged 20-50 years and 82 (52.90%) were 51-80 years of age. The frequencies of coronary risk factors were stratified according to sex and the two age groups. Seventy-one patients (45.80%) had diabetes mellitus, 83 (53.54%) had hypertension, 55 (35.48%) were smokers, 46 (29.68%) had dyslipidemia, and 47 (30.3%) were obese. Hypertension is the leading coronary risk factors in patients with acute coronary syndrome solely due to coronary ectasia, followed by diabetes mellitus and smoking.

Spontaneous coronary artery dissection in young female acute coronary syndrome patients: a single-centre retrospective cohort study

Background Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS), rapidly gaining recognition over the last decade. SCAD occurs predominantly in young, otherwise healthy women and coronary angiogram often lacks typical (atherosclerotic) features. Therefore, SCAD remains notably underdiagnosed. As optimal treatment strategy differs greatly from atherosclerotic ACS, early (differential) diagnosis is crucial. Purpose/Methods In this paper, all coronary angiograms performed for ACS in women up to 50 years of age were retrospectively reviewed by three independent interventional cardiologists. Results The obtained insights are comparable to recent literature. SCAD incidence was 26% in this cohort. Left anterior descending coronary artery was the main affected vessel with SCAD subtype 2B as predominant angiographic presentation. Correct diagnosis during index procedure was poor with only 33% accuracy. Nevertheless, a favourable trend over time was noted. Percutaneous coronary intervention success was 56%, as in 44% of patients initial stenting was complicated by progressive dissection. Overall, outcome was excellent with no reported fatalities. Conclusion SCAD remains an underdiagnosed subtype of ACS and the importance of increasing awareness amongst (interventional) cardiologists needs to be emphasised.

Acute Coronary Syndrome with Non-ruptured Plaques (NONRUPLA): Novel Ideas and Perspectives.

In this review article, we focus on the mechanisms and features of acute coronary syndromes (ACS) with no ruptured plaque (NONRUPLA) highlighting the uncertainties over diagnostic evaluation and treatment. The most common cause of ACS is obstruction due to atherosclerotic plaque ruptured or erosion. In 14% of patients who present in the Emergency Department as myocardial infarction, the final diagnosis is ACS with NONRUPLA. Although the clinical presentation of NONRUPLA may mimic myocardial infarction, the underlying pathogenesis is different, and it may guide therapeutic approaches and overall prognosis that vary according to etiology. The possible mechanisms of ACS with NONRUPLA are coronary embolism, acute dissection of the aorta or coronary artery, vasospasm, microvascular dysfunction, the imbalance between oxygen demand and supply, coronary trauma and stent complications, direct cellular toxicity and damage, Takotsubo syndrome, and myocardial infarction with non-obstructive coronary arteries (MINOCA).

ST Elevation Myocardial Infarction as Presenting Feature of C-ANCA Vasculitis: A Case of a Diagnostic Dilemma.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Although uncommon, it should be included in the differential diagnosis for middle-aged patients without elevated atherosclerotic vascular disease risk or a family history of cardiovascular disease. SCAD is associated with postpartum women; however, reports noting its association with autoimmune disease and vasculopathy in other populations have recently gained prominence. We report a case of a 41-year-old male who was found to have SCAD after presenting with ST segment elevation myocardial infarction in the context of episodic vision loss, and who later underwent work-up for C-ANCA vasculitis and was successfully treated with corticosteroids.LEARNING POINTSSCAD is most common in middle-aged females. However, it can present in male patients, and it should raise suspicion of underlying vasculopathy.Eosinophilic vasculitis may mimic parasitic infection.C-ANCA vasculitis can be associated with SCAD.

Endothelial Dysfunction Is Not Associated With Spontaneous Coronary Artery Dissection

BackgroundSpontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome, yet its pathophysiology is only partially understood. We sought to assess the association between endothelial dysfunction (ED) and SCAD. MethodsWe prospectively assessed patients presenting with acute coronary syndrome who were diagnosed with SCAD. The control arm had established coronary artery atherosclerotic disease (AD) according to previous coronary angiography. ED was assessed using the EndoPAT 2000 while patients returned to their steady state condition. A total of 16 patients with SCAD and 66 patients with AD were included. ResultsMicrovascular reactivity as assessed with the EndoPAT was significantly worse in the AD group compared to the SCAD group. The median RHI in the AD group was 1.76 (IQR 1.52, 2.2) vs. a median RHI of 2.08 (IQR 1.73, 2.79) in the SCAD group (p < 0.05). While the RHI values in half of the AD group (33 patients; 50%) were below the cut-off of 1.67 only one patient had an RHI below this cut-off in the SCAD group. ConclusionsPatients with SCAD were not found to have ED and it is therefore unlikely that ED takes part in SCAD formation.

Spontaneous coronary artery dissection in Spain: clinical and angiographic characteristics, management, and in-hospital events

Introduction and objectivesSpontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome. The characteristics and in-hospital clinical course of patients with SCAD in Spain remain unknown. MethodsWe present data from consecutive patients included in the national prospective SCAD registry. Angiographic analysis was performed in a centralized core laboratory. ResultsBetween June 2015 and April 2019, we included 318 patients with SCAD (358 lesions) from 31 centers. Median age was 53 years, and 88% were women. The most frequent presentation was non–ST-segment elevation acute myocardial infarction (53%). The most frequently involved artery was the left anterior descending coronary artery (44%), predominantly affecting the distal segments (39%) and secondary branches (54%). Most lesions (62%) appeared on angiography as intramural hematoma, without double lumen. Conservative management was selected as the initial approach in most patients (78%). During the index admission, 6% of patients had a major adverse event and 4 patients (1.3%) died. Independent predictors of adverse events were initial management with percutaneous coronary intervention (OR, 5.97; P=.004) and angiographic presentation as intramural hematoma (OR, 4.96; P=.028). ConclusionsIn Spain, SCAD affects mainly middle-aged women. In most patients, the initial management strategy was conservative with excellent in-hospital survival. Initial management with percutaneous coronary intervention and angiographic presentation as intramural hematoma were related to the presence of in-hospital adverse events.Registered at ClnicalTrials.gov (Identifier: NCT03607981).

Identification of Susceptibility Loci for Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD), an idiopathic disorder that predominantly affects young to middle-aged women, has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden cardiac death. To identify common single-nucleotide variants (SNVs) associated with SCAD susceptibility. This single-center genome-wide association study examined approximately 5 million genotyped and imputed SNVs and subsequent SNV-targeted replication analysis results in individuals enrolled in the Mayo Clinic SCAD registry from August 30, 2011, to August 2, 2018. Data analysis was performed from June 21, 2017, to December 30, 2019. Genetic loci and positional candidate genes associated with SCAD. This study included 484 white women with SCAD (mean [SD] age, 46.6 [9.2] years) and 1477 white female controls in the discovery cohort (mean [SD] age, 64.0 [14.5] years) and 183 white women with SCAD (mean [SD] age, 47.1 [9.9] years) and 340 white female controls in the replication cohort (mean [SD] age, 51.0 [15.3] years). Associations with SCAD risk reached genome-wide significance at 3 loci (1q21.3 [OR, 1.78; 95% CI, 1.51-2.09; P = 2.63 × 10-12], 6p24.1 [OR, 1.77; 95% CI, 1.51-2.09; P = 7.09 × 10-12], and 12q13.3 [OR, 1.67; 95% CI, 1.42-1.97; P = 3.62 × 10-10]), and 7 loci had evidence suggestive of an association (1q24.2 [OR, 2.10; 95% CI, 1.58-2.79; P = 2.88 × 10-7], 3q22.3 [OR, 1.47; 95% CI, 1.26-1.71; P = 6.65 × 10-7], 4q34.3 [OR, 1.84; 95% CI, 1.44-2.35; P = 9.80 × 10-7], 8q24.3 [OR, 2.57; 95% CI, 1.76-3.75; P = 9.65 × 10-7], 15q21.1 [OR, 1.75; 95% CI, 1.40-2.18; P = 7.23 × 10-7], 16q24.1 [OR, 1.91; 95% CI, 1.49-2.44; P = 2.56 × 10-7], and 21q22.11 [OR, 2.11; 95% CI, 1.59-2.82; P = 3.12 × 10-7]) after adjusting for the top 5 principal components. Associations were validated for 5 of the 10 risk alleles in the replication cohort. In a meta-analysis of the discovery and replication cohorts, associations for the 5 SNVs were significant, with relatively large effect sizes (1q21.3 [OR, 1.77; 95% CI, 1.54-2.03; P = 3.26 × 10-16], 6p24.1 [OR, 1.71; 95% CI, 1.49-1.97; P = 4.59 × 10-14], 12q13.3 [OR, 1.69; 95% CI, 1.47-1.94; P = 1.42 × 10-13], 15q21.1 [OR, 1.79; 95% CI, 1.48-2.17; P = 2.12 × 10-9], and 21q22.11 [OR, 2.18; 95% CI, 1.70-2.81; P = 1.09 × 10-9]). Each index SNV was within or near a gene highly expressed in arterial tissue and previously linked to SCAD (PHACTR1) and/or other vascular disorders (LRP1, LINC00310, and FBN1). This study revealed 5 replicated risk loci and positional candidate genes for SCAD, most of which are associated with extracoronary arteriopathies. Moreover, the alternate alleles of 3 SNVs have been previously associated with atherosclerotic coronary artery disease, further implicating allelic susceptibility to coronary artery atherosclerosis vs dissection.

Characteristic findings of acute spontaneous coronary artery dissection by cardiac computed tomography.

Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS); however, its detection carries relevant clinical implications. Cardiac computed tomography (CCT) has been found to be useful for follow-up, but data during the acute phase are scarce. Thus, our aim was to evaluate the early diagnostic ability of CCT to detect SCAD. We retrospectively analyzed all the in-hospital CCT performed in a prospective cohort of patients with SCAD from 2012 to 2016. An independent expert blindly evaluated the studies and described the radiologic characteristics of the lesions. These features were compared with the invasive coronary angiography (ICA) and optical coherence tomography (OCT) findings. 18 lesions were analyzed from 12 episodes identified in 11 patients (100% females; median age of 57 years old). CCT recognized the presence of SCAD in 14 (78%) of the lesions, with four different morphological patterns. Most commonly (10, 71%) SCAD presented as a diffuse lumen narrowing surrounded by a 'sleeve-like' wall thickening, which corresponded to intramural hematoma in OCT evaluation. When compared with ICA, CCT showed a positive correlation (Spearman's Rho = 0.775; P = 0.001) and excellent concordance (ICC = 0.8; P = 0.004) in stenosis grading, but not for lesion length and minimal luminal area. CCT was able to identify the presence of SCAD in most of the patients in the acute phase of this elusive and challenging clinical entity. In addition, in this setting, CCT revealed unique and distinct radiologic features and provided a precise assessment of lesion severity.

Acute Coronary Syndrome in Women: An Overview.

For decades, cardiovascular disease—specifically, myocardial infarction (MI)—was thought to be a disease of men. The major acute coronary syndrome (ACS) trials that guide daily clinical practice disproportionately enrolled men, thus promoting this fallacy. Fortunately, the medical literature and the lay media have increasingly recognized that heart disease is the primary cause of death in women and that cardiovascular disease has no sex preference.Traditional cardiac risk factors of diabetes, smoking, obesity, and hypertension affect the cardiovascular system differently in men and women.1 In the INTERHEART study of more than 27,000 patients, diabetes increased risk in women 4-fold, but only 2.5-fold in men. In a 12-year follow-up to a Norwegian epidemiologic study, smoking increased a woman's risk more than a man's (relative risk, 3.3 vs 1.9), especially in women 35 to 44 years old (relative risk, 7.1 vs 2.3).2 Women are thought to be protected from cardiovascular disease, particularly coronary artery disease, by endogenous estrogen, which has wide-ranging effects throughout the circulatory system.3 Estrogen positively affects the cholesterol profile by increasing high-density lipoproteins and decreasing low-density lipoproteins.4 Estrogen also relaxes smooth muscle cells, leading to lower blood pressure, and is thought to assist in the body's clearance of cellular free radicals that may otherwise increase inflammatory processes and promote cardiovascular disease.5Loss of the beneficial estrogen effect after menopause may help explain why women present later in life with cardiovascular disease, particularly ACS. Interestingly, replacing estrogen after menopause has not proved beneficial and actually increases cardiovascular risk (both arterial and venous).6 In the GUSTO IIb (Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes) trial, women who presented with ACS were older and more likely than men to have diabetes, hypertension, and congestive heart failure.7,8 However, after 70 years of age, these differences became less pronounced, thus supporting the loss-of-estrogen theory.9Women and men with ACS may present with different symptoms. In a large review of patients with ACS, 37% of women and 27% of men reported no chest pain.10 Women more often reported upper back, neck, or jaw pain; dyspnea; and weakness.Not recognizing symptoms often delays diagnosis of ACS. However, even after diagnosis, women are less likely than men to be referred for coronary angiography, percutaneous intervention, and fibrinolysis, which delays definitive treatment for many and places the myocardium at further risk. Women also receive less intensive medical therapy both during and after an ACS event. These sex-related factors cumulatively have lasting effects, and post-ACS outcomes are consistently poorer in women than in men.11The pathophysiology of ACS may also differ by sex. Plaque erosion is the most frequent cause of ACS in women; in men, it is plaque rupture.12 Plaque erosion is seen on intravascular imaging in up to one third of women with ACS, even when no lesions are identifiable angiographically.12 Plaque rupture, in contrast, is more easily identifiable angiographically.12 Spontaneous coronary artery dissection (SCAD), an uncommon cause of ACS, occurs almost exclusively in women. In a prospective cohort of patients with SCAD, more than 90% of patients were female; in addition, 25.7% of all patients presented with ST-segment-elevation MI, and 74.3% presented with non-ST-segment-elevation MI.13 A high degree of suspicion for SCAD is crucial in women with ACS because immediate medical therapy may provide better outcomes than percutaneous coronary intervention.13 Although there is no consensus on medical therapy for SCAD, most women are treated with aspirin and β-blockers. This combination can lower the risk of recurrence, but in approximately 10% of patients, it will not prevent it.13Meanwhile, the medical community continues to raise awareness of cardiovascular disease as the leading cause of death and an important driver of morbidity and mortality in both sexes, with a growing emphasis on the need to study its effects in women. Recognizing sex disparities in the diagnosis and treatment of cardiovascular disease is of the utmost importance.

Disección coronaria espontánea en España: características clínicas y angiográficas, tratamiento y evolución hospitalaria

Introduction and objectivesSpontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome. The characteristics and in-hospital clinical course of patients with SCAD in Spain remain unknown. MethodsWe present data from consecutive patients included in the national prospective SCAD registry. Angiographic analysis was performed in a centralized core laboratory. ResultsBetween June 2015 and April 2019, we included 318 patients with SCAD (358 lesions) from 31 centers. Median age was 53 years, and 88% were women. The most frequent presentation was non–ST-segment elevation acute myocardial infarction (53%). The most frequently involved artery was the left anterior descending coronary artery (44%), predominantly affecting the distal segments (39%) and secondary branches (54%). Most lesions (62%) appeared on angiography as intramural hematoma, without double lumen. Conservative management was selected as the initial approach in most patients (78%). During the index admission, 6% of patients had a major adverse event and 4 patients (1.3%) died. Independent predictors of adverse events were initial management with percutaneous coronary intervention (OR, 5.97; P=.004) and angiographic presentation as intramural hematoma (OR, 4.96; P=.028). ConclusionsIn Spain, SCAD affects mainly middle-aged women. In most patients, the initial management strategy was conservative with excellent in-hospital survival. Initial management with percutaneous coronary intervention and angiographic presentation as intramural hematoma were related to the presence of in-hospital adverse events.Registered at ClnicalTrials.gov (Identifier: NCT03607981).