Coronary Artery Dissection Research Articles

A Case of Spontaneous Coronary Artery Dissection Secondary to Fibromuscular Dysplasia

A Case of Spontaneous Coronary Artery Dissection Secondary to Fibromuscular Dysplasia

Predictors of Major Adverse Cardiovascular Events: First Report From the Australian-New Zealand Spontaneous Coronary Artery Dissection (ANZ-SCAD) Registry

Predictors of Major Adverse Cardiovascular Events: First Report From the Australian-New Zealand Spontaneous Coronary Artery Dissection (ANZ-SCAD) Registry

Retrospective Analysis of Angiographically-Diagnosed Spontaneous Coronary Artery Dissection: 7-Year Experience in a Regional Cardiac Centre

Retrospective Analysis of Angiographically-Diagnosed Spontaneous Coronary Artery Dissection: 7-Year Experience in a Regional Cardiac Centre

Recurrent Spontaneous Coronary Artery Dissection in a Young Male: A Case Report

Recurrent Spontaneous Coronary Artery Dissection in a Young Male: A Case Report

Clinical features of acute coronary syndrome associated with spontaneous coronary artery dissection in women: a case series

Spontaneous coronary artery dissection (SCAD) is defined as a spontaneous dissection of the coronary artery wall that occurs independently of atherosclerosis, percutaneous coronary intervention, or mechanical trauma. Its distinctive feature is high prevalence in young women. This condition is associated with pregnancy and hormonal changes. A number of risk factors have been identified, including vascular pathology (most commonly fibromuscular dysplasia), other hereditary connective tissue disorders, systemic inflammatory diseases, migraine, and thyroid diseases. Nevertheless, the precise mechanisms of the pathophysiological relationship remain to be elucidated, and risk factors cannot be identified in all patients, indicating the complex and incompletely understood nature of the disease. The present article presents a case series on the development of SCAD in women and a review of the predisposing factors for the disease.

MI and Non-obstructive Coronary Arteries.

MI and non-obstructive coronary arteries (MINOCA) is recognized as an important contributor to adverse cardiovascular outcomes in both men and women but is particularly prevalent in young women. Multiple coronary mechanisms such as coronary plaque disruption, coronary artery spasm, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary thromboembolism can trigger MINOCA. Beyond routine left heart catheterization, invasive intracoronary imaging and cardiac MRI can help to clarify the cause of MINOCA. Conditions such as myocarditis, takotsubo syndrome, and cardiomyopathy are on the differential as alternate explanations in those suspected of MINOCA. Identification of the underlying cause in a case of MINOCA has therapeutic implications. While long-term management of MINOCA is not standardized, angiotensin converting enzyme inhibitors and statins appear to be of benefit. In this review, we discuss the prevalence and pathophysiology of MINOCA, diagnostic considerations, and current treatment approaches to manage this high-risk group of patients.

Recurrent spontaneous coronary artery dissection with ST-segment elevation: once RCA involvement then left main/LAD—case report

BackgroundSpontaneous coronary artery dissection is a rare disease with a more prevalence in women, mostly in the postpartum state, which was first described by Peretti in 1931.Case presentationThis report describes a previously healthy woman who had a spontaneous coronary artery dissection. This case is related to the early postpartum period with a successful outcome. In addition, the diagnostic and therapeutic approaches of this unique clinical entity are discussed and reviewed.ConclusionsBecause these kinds of cases are so rare, reporting these cases and the management and treatment approaches can guide other clinicians worldwide, and maybe a guideline for choosing the best approach around different situations could be published.

Management After Spontaneous Coronary Artery Dissection in Pregnancy

Management After Spontaneous Coronary Artery Dissection in Pregnancy

Uncovering a hidden danger: a case report of diffuse coronary spasm concealing spontaneous coronary artery dissection

BackgroundOver recent years, spontaneous coronary artery dissection (SCAD) has emerged as a no longer rare cause of acute coronary syndrome (ACS). On the other hand, coronary artery spasm (CAS) is the main cause of ischemic heart disease with non-obstructive coronary lesions. Clinical manifestations of both vary from stable angina to ACS or, rarely, sudden cardiac death. These entities may be underdiagnosed on a coronary angiography.Case presentationWe report the case of a young woman presenting with acute chest pain and no coronary risk factors. Angiography revealed a focal subcritical stenosis of the right coronary artery. Coronary wiring resulted in diffuse and critical spasm. However, optical coherence tomography (OCT) and intravascular ultrasound (IVUS) showed extensive SCAD. She was therefore treated conservatively. On the fourth day, cardiac computed tomography angiography (CCTA) excluded disease progression, and then she was discharged on medical therapy.ConclusionsCombined IVI plays a vital role in providing accurate and detailed visualization of the coronary anatomy and thus allowing for more precise diagnosis, risk stratification, and treatment planning. CCTA can be considered a valuable tool in the noninvasive follow-up of SCAD.

Spontaneous Coronary Artery Dissection: A Case Series and Review of the Literature.

Although previously considered rare, spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction in young women. We present three unique cases of SCAD: A 46-year-old woman with a history of trigeminal neuralgia and anxiety presenting elevated troponin-I and chest pain. A 36-year-old woman with recent miscarriage presenting with diffuse T wave inversions and elevated troponin-I. A 58-year-old man with a recent COVID-19 infection presenting with diffuse ST elevations. SCAD is associated with many risk factors. Conservative management is preferred due to spontaneous healing of vessels compared to PCI-driven management of atherosclerotic acute coronary syndrome.

Obstetric anesthesia considerations in pregnancy-associated myocardial infarction: a focused review

Pregnancy-associated myocardial infarction (PAMI) is a rare but serious complication that can occur either during pregnancy or postpartum. The etiologies of PAMI are atherosclerosis, spontaneous coronary artery dissection, coronary thrombosis, coronary embolism, and coronary vasospasm. Therapy of acute PAMI depends largely on the ECG presentation, hemodynamic stability, and suspected etiology of myocardial infarction. Anesthetic management during delivery in patients with PAMI should consist of early and carefully titrated neuraxial analgesia and anesthesia, maintenance of normal sinus rhythm, preservation of afterload, and monitoring for and avoiding myocardial ischemia. To improve the care of women with PAMI, a multidisciplinary team of cardiologists, maternal fetal medicine specialists, obstetric providers, neonatologists, and anesthesiologists must work collectively to manage these complex patients.

Impact of Familial Hypercholesterolemia on Coronary Artery Dissection in Patients Undergoing Percutaneous Coronary Intervention (PCI)

Impact of Familial Hypercholesterolemia on Coronary Artery Dissection in Patients Undergoing Percutaneous Coronary Intervention (PCI)

Evaluating the incidence and risk factors for developing acute tubular necrosis after percutaneous coronary intervention in the management of coronary artery dissection

BackgroundCoronary artery dissection is managed primarily conservatively with serial imaging or percutaneous coronary intervention (PCI). Exposure to contrast in either modality could potentially result in acute tubular necrosis (ATN). However, no data compares ATN incidence in these management strategies. This study compares the incidence of ATN and associated mortality of PCI and conservative management of coronary artery dissection. MethodsA retrospective analysis was performed using data from the National Inpatient Sample database, including patients with coronary artery dissection between 2016 through 2020. We analyzed the incidence of ATN and associated mortality of PCI and conservative management of coronary artery dissection. ResultsWe found that the odds of developing ATN were 22% lower in patients managed with PCI than those managed conservatively. There was no difference in the in-hospital mortality or hospital length of stay between the two groups but the mortality rate in patients with ATN was double that of those who did not develop ATN in both PCI and conservatively managed groups. ConclusionsThe higher incidents of ATN in patients with coronary dissection being managed with conservative measures compared to PCI suggest that the use of CTA may be harmful. Additionally, persons who developed ATN may have higher mortality. Therefore, more studies in the management of coronary artery dissection need to be done which would allow further steps to be taken to reduce this harm.

Spontaneous Coronary Artery Dissection in Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review of the Literature.

Spontaneous coronary artery dissection (SCAD) is a spontaneous intimal tear of the coronary artery wall. A factor rarely associated with SCAD is autosomal dominant polycystic kidney disease (ADPKD). Using the PRISMA guidelines, we identified 10 unique cases of SCAD in ADPKD patients reported between 1998 and 2021. Ages ranged from 36 to 59 years, with an average of 44.6 years. The majority of patients were female (80%). Each case was diagnosed with a cardiovascular event: ST-elevation myocardial infarction (STEMI) in 40%, non-ST elevation myocardial infarction (NSTEMI) in 50%, and stable angina in 10%. Conservative management was used in 60% of cases. There is a significant gap in our understanding of the relationship between SCAD and ADPKD. Polycystin complex can lead to structural abnormalities in blood vessels, resulting in vascular leaks and vessel rupture. This suggests that ADPKD patients may have an elevated risk of arteriopathies, including coronary artery dissection.

Understanding anxiety and depression after spontaneous coronary artery dissection: targets for intervention

Understanding anxiety and depression after spontaneous coronary artery dissection: targets for intervention

Cognitive and physical fatigue: the experience and consequences of 'brain fog' after Spontaneous Coronary Artery Dissection (SCAD), a qualitative study.

Brain fog and fatigue are common issues after acute coronary syndrome. However, little is known about the nature and impact of these experiences in spontaneous coronary artery dissection (SCAD) survivors. The aims of this study were to understand the experiences of brain fog and the coping strategies used after SCAD. Participants were recruited from the Victor Chang Cardiac Research Institute Genetics Study database and were considered eligible if their event occurred within 12-months. Seven semi-structured online focus groups were conducted between December to January 2021-2022, with this study reporting findings related to brain fog and fatigue. Interviews were transcribed and thematically analysed using an iterative approach. Participants (N=30) were a mean age of 52.2 ((9.5) and mostly female (n=27, 90%). The overarching theme of brain fog after SCAD included four main themes: how brain fog is experienced, perceived causes, impacts, and how people cope. Experiences included memory lapses, difficulty concentrating and impaired judgement, and perceived causes included medication, fatigue and tiredness, and menopause and hormonal changes. Impacts of brain fog included rumination, changes in self-perception, disruption to hobbies/pastimes, and limitations at work. Coping mechanisms included setting reminders and expectations, being one's own advocate, lifestyle and self-determined medication adjustments, and support from peers. Brain fog is experienced by SCAD survivors and the impacts are varied and numerous, including capacity to work. SCAD survivors reported difficulty understanding causes and found their own path to coping. Recommendations for clinicians are provided.

The genetics of spontaneous coronary artery dissection: a scoping review.

Spontaneous coronary artery dissection (SCAD) is a multifactorial process that involves predisposing factors and precipitating stressors. Genetic abnormality has been implicated to play a mechanistic role in the development of SCAD. This systematic review aims to summarize the current evidence concerning the link between SCAD and genetic abnormalities. We reviewed original studies published until May 2023 that reported SCAD patients with a genetic mutation by searching PubMed, Embase Ovid, and Google Scholar. Registries, cohort studies, and case reports were included if a definitive SCAD diagnosis was reported, and the genetic analysis was performed. Exclusion criteria included editorials, reviews, letters or commentaries, animal studies, meeting papers, and studies from which we were unable to extract data. Data were extracted from published reports. A total of 595 studies were screened and 55 studies were identified. Among 116 SCAD patients with genetic abnormalities, 20% had mutations in the COL gene, 13.70% TLN1 gene, and 8.42% TSR1 gene. Mutations affecting the genes encoding COL and TLN1 were most frequently reported (20 and 13.7%, respectively). Interestingly, 15 genes of this collection were also reported in patients with thoracic aortic diseases as well. The genetic commonality between fibromuscular dysplasia (FMD) and SCAD was also included. In this review, the inherited conditions and reported genes of undetermined significance from case reports associated with SCAD are collected. A brief description of the encoded protein and the clinical features associated with pathologic genes is provided. Current data suggested that the diagnostic yield of genetic studies for patients with SCAD would be low and routine genetic screening of such patients with no clinical features indicative of associated disorders remains debatable. This review can be used as a guide for clinicians to recognize inherited syndromic and nonsyndromic disorders associated with SCAD.

Spontaneous Coronary Artery Dissection and Tear Repair: A Comprehensive Review of Pathophysiology, Diagnosis, and Therapeutic Interventions

Spontaneous Coronary Artery Dissection (SCAD) represents a rare but significant cause of acute coronary syndrome, predominantly affecting young to middle-aged women without traditional cardiovascular risk factors. The pathophysiology of SCAD involves the spontaneous development of an intimal tear or the formation of an intramural hematoma, leading to coronary artery obstruction and myocardial ischemia. Diagnosing SCAD is challenging due to its varied presentation and the need for high-resolution imaging techniques. Management strategies for SCAD are diverse, ranging from conservative medical therapy to percutaneous coronary intervention (PCI) and, in severe cases, surgical repair. This review aims to provide a detailed analysis of the pathophysiological mechanisms, diagnostic criteria, and therapeutic approaches for the repair of SCAD, highlighting recent advancements in interventional cardiology and surgical techniques.

Racial Disparities in Outcomes of Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Secondary to Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a rare cause of ST-segment elevation myocardial infarction (STEMI), predominantly affecting women. Because primary percutaneous coronary intervention (PPCI) is reserved for a select group of patients, vulnerable and minority patients may suffer delays in appropriate management and adverse outcomes. We examined racial differences in the outcomes for SCAD patients undergoing PPCI for STEMI. Records of patients ≥18 years old who underwent PPCI for SCAD-related STEMI between 2016 and 2020 were identified from the National Inpatient Sample database. Clinical, socioeconomic, and hospital characteristics were compared between non-White and White patients. Weighted multivariate analysis assessed the association of race with inpatient mortality, length of stay (LOS), and hospitalization costs. The total weighted estimate of SCAD-STEMI patients undergoing PPCI was 4945, constituting 25% non-White patients. Non-White patients were younger (56 vs. 60.7 years, p<0.001), had a higher prevalence of diabetes, acute renal failure, and obesity, and were more likely to be uninsured and be in the lowest income group. Inpatient mortality (7.7% vs. 8.4%, p=0.74) and hospitalization costs ($34213 vs. $31858, p=0.27) were similar for non-White and White patients, and adjusted analysis did not show any association between patients’ race and inpatient mortality (odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.32-1.13; p=0.11) or hospitalization costs (β: 215; 95% CI: -4193 to 4623; p>0.90). Similarly, there was no association between patients’ race and LOS (incident rate ratio: 1.20; 95% CI: 1.00-1.45; p=0.054]. Weighted multivariate analysis showed that age; clinical comorbidities such as diabetes, acute renal failure, valvular dysfunction, and obesity; low-income status; and hospitalization in the Western region were associated with adverse outcomes. In conclusion, our study does not show any differences in inpatient mortality, length of stay, and hospitalization costs between non-White and White patients undergoing PPCI for SCAD-related STEMI.

Cardiovascular Disease in Women Challenges and Differences in Diagnosis and Management

Cardiovascular Disease (CVD) is a leading cause of morbidity and mortality in women worldwide. Biologic and sociocultural factors account for the variation in presentation and natural history of CVD in women. Research in the last two decades focusing on CVD in women has led to an improved understanding of conventional and novel risk factors, sex specific pathophysiology of Ischemic heart disease (IHD). The salient features of IHD in women are a higher prevalence of risk factors, angina, lower burden of obstructive coronary artery disease and a poorer prognosis in comparison with men. Evaluation and management of disease with higher prevalence in women including myocardial infarction with non obstructive coronary arteries (MINOCA), stress induced cardiomyopathy (Takotsubo syndrome) and spontaneous coronary artery dissection (SCAD) are discussed.