PMID- 23078737
OWN - NLM
STAT- MEDLINE
DCOM- 20130410
LR  - 20221207
IS  - 1876-7605 (Electronic)
IS  - 1936-8798 (Linking)
VI  - 5
IP  - 10
DP  - 2012 Oct
TI  - Spontaneous coronary artery dissection: long-term follow-up of a large series of 
      patients prospectively managed with a "conservative" therapeutic strategy.
PG  - 1062-70
LID - S1936-8798(12)00755-8 [pii]
LID - 10.1016/j.jcin.2012.06.014 [doi]
AB  - OBJECTIVES: This study sought to assess the long-term clinical outcome of 
      patients with spontaneous coronary artery dissection (SCD) managed with a 
      conservative strategy. BACKGROUND: SCD is a rare, but challenging, clinical 
      entity. METHODS: A prospective protocol, including a conservative management 
      strategy, was followed. Revascularization was only considered in cases with 
      ongoing/recurrent ischemia. Inflammatory/immunologic markers were systematically 
      obtained. RESULTS: Forty-five consecutive patients (incidence 0.27%) were studied 
      during a 6-year period. Of these, 27 patients (60%) had "isolated" SCD (I-SCD), 
      and 18 had SCD associated with coronary artery disease (A-SCD). Age was 53 +/- 11 
      years, and 26 patients were female. Most patients presented with an acute 
      myocardial infarction. SCD had a diffuse angiographic pattern (length: 31 +/- 23 
      mm). In 11 patients, the diagnosis was confirmed by intracoronary imaging 
      techniques. Sixteen patients (35%) required revascularization during initial 
      admission. One patient died after surgery, but no additional patient experienced 
      recurrent myocardial infarction. No significant inflammatory/immunologic 
      abnormalities were detected. At follow-up (median 730 days), only 3 patients 
      presented with adverse events (1 died of congestive heart failure, and 2 required 
      revascularization). No patient experienced a myocardial infarction or died 
      suddenly. Event-free survival was similar (94% and 88%, respectively) in patients 
      with I-SCD and A-SCD. Notably, at angiographic follow-up, spontaneous 
      "disappearance" of the SCD image was found in 7 of 13 (54%) patients. 
      CONCLUSIONS: In this large prospective series of consecutive patients with SCD, a 
      "conservative" therapeutic strategy provided excellent long-term prognosis. 
      Clinical outcome was similar in patients with I-SCD and A-SCD. The natural 
      history of SCD includes spontaneous healing with complete resolution.
CI  - Copyright (c) 2012 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Alfonso, Fernando
AU  - Alfonso F
AD  - Interventional Cardiology, Cardiovascular Institute, Clinico San Carlos, 
      University Hospital, IdISSC, Madrid, Spain. falf@hotmail.com
FAU - Paulo, Manuel
AU  - Paulo M
FAU - Lennie, Vera
AU  - Lennie V
FAU - Dutary, Jaime
AU  - Dutary J
FAU - Bernardo, Esther
AU  - Bernardo E
FAU - Jimenez-Quevedo, Pilar
AU  - Jimenez-Quevedo P
FAU - Gonzalo, Nieves
AU  - Gonzalo N
FAU - Escaned, Javier
AU  - Escaned J
FAU - Banuelos, Camino
AU  - Banuelos C
FAU - Perez-Vizcayno, Maria J
AU  - Perez-Vizcayno MJ
FAU - Hernandez, Rosana
AU  - Hernandez R
FAU - Macaya, Carlos
AU  - Macaya C
LA  - eng
PT  - Journal Article
PL  - United States
TA  - JACC Cardiovasc Interv
JT  - JACC. Cardiovascular interventions
JID - 101467004
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Aortic Dissection/*drug therapy/mortality/therapy
MH  - Angioplasty, Balloon, Coronary
MH  - Anticoagulants/therapeutic use
MH  - Coronary Aneurysm/*drug therapy/mortality/therapy
MH  - Coronary Angiography
MH  - Coronary Artery Disease/pathology
MH  - Coronary Vessels/*pathology
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Prospective Studies
MH  - Spain
MH  - Statistics, Nonparametric
MH  - Survival Analysis
MH  - Time Factors
EDAT- 2012/10/20 06:00
MHDA- 2013/04/11 06:00
CRDT- 2012/10/20 06:00
PHST- 2012/03/13 00:00 [received]
PHST- 2012/05/15 00:00 [revised]
PHST- 2012/06/07 00:00 [accepted]
PHST- 2012/10/20 06:00 [entrez]
PHST- 2012/10/20 06:00 [pubmed]
PHST- 2013/04/11 06:00 [medline]
AID - S1936-8798(12)00755-8 [pii]
AID - 10.1016/j.jcin.2012.06.014 [doi]
PST - ppublish
SO  - JACC Cardiovasc Interv. 2012 Oct;5(10):1062-70. doi: 10.1016/j.jcin.2012.06.014.