PMID- 27621835
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160913
LR  - 20231104
IS  - 2053-3624 (Print)
IS  - 2053-3624 (Electronic)
IS  - 2053-3624 (Linking)
VI  - 3
IP  - 2
DP  - 2016
TI  - Outcomes of patients with spontaneous coronary artery dissection.
PG  - e000491
LID - 10.1136/openhrt-2016-000491 [doi]
LID - e000491
AB  - BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an uncommon but 
      serious condition presenting as an acute coronary syndrome (ACS) or cardiac 
      arrest. The pathophysiology and outcomes are poorly understood. We investigated 
      the characteristics and outcomes of patients presenting with SCAD. METHODS: In a 
      retrospective study of a large cohort of patients with SCAD, data were collected 
      regarding clinical presentation, patient characteristics, vascular screening, 
      coronary artery involvement and clinical outcomes. RESULTS: 40 patients with SCAD 
      (95% women, mean age 45+/-10 years) were included. At least 1 traditional 
      cardiovascular risk factor was present in 40% of patients. Migraine was reported 
      in 43% of patients. Events preceding SCAD included parturition (8%), physical 
      stress (13%), emotional stress (10%) and vasoconstrictor substance-use (8%). 65% 
      of patients had a non-ST elevation ACS (NSTEACS) at presentation, 30% had an ST 
      elevation myocardial infarction (STEMI) and 13% had a cardiac arrest. The left 
      anterior descending artery was most frequently involved (68% of patients), and 
      13% had involvement of multiple coronary territories. Fibromuscular dysplasia 
      (FMD) was identified in 7 (37%) of 19 patients screened. 68% of patients were 
      managed medically, 30% had percutaneous coronary intervention and 5% had coronary 
      artery bypass grafting. Over a median 16-month follow-up period, 8% of patients 
      had at least 1 recurrent SCAD event. There were no deaths. CONCLUSIONS: Patients 
      with SCAD in this study often had multiple coronary territories involved (13%) 
      and extracardiac vascular abnormalities, suggesting a systemic vascular process, 
      which may explain the high incidence of migraine. All patients with SCAD should 
      be screened for FMD and followed closely due to the possibility of recurrence.
FAU - McGrath-Cadell, Lucy
AU  - McGrath-Cadell L
AD  - St Vincent's Hospital , Darlinghurst, New South Wales , Australia.
FAU - McKenzie, Pamela
AU  - McKenzie P
AD  - Busselton, Western Australia , Australia.
FAU - Emmanuel, Sam
AU  - Emmanuel S
AD  - St Vincent's Hospital , Darlinghurst, New South Wales , Australia.
FAU - Muller, David W M
AU  - Muller DW
AD  - St Vincent's Hospital , Darlinghurst, New South Wales , Australia.
FAU - Graham, Robert M
AU  - Graham RM
AD  - Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, 
      Australia; St Vincent's Clinical School, University of New South Wales, 
      Kensington, New South Wales, Australia.
FAU - Holloway, Cameron J
AU  - Holloway CJ
AD  - St Vincent's Hospital, Darlinghurst, New South Wales, Australia; Victor Chang 
      Cardiac Research Institute, Darlinghurst, New South Wales, Australia; St 
      Vincent's Clinical School, University of New South Wales, Kensington, New South 
      Wales, Australia.
LA  - eng
PT  - Journal Article
DEP - 20160824
PL  - England
TA  - Open Heart
JT  - Open heart
JID - 101631219
PMC - PMC5013459
OTO - NOTNLM
OT  - CORONARY ARTERY DISEASE
EDAT- 2016/09/14 06:00
MHDA- 2016/09/14 06:01
PMCR- 2016/08/24
CRDT- 2016/09/14 06:00
PHST- 2016/06/27 00:00 [received]
PHST- 2016/07/26 00:00 [revised]
PHST- 2016/08/02 00:00 [accepted]
PHST- 2016/09/14 06:00 [entrez]
PHST- 2016/09/14 06:00 [pubmed]
PHST- 2016/09/14 06:01 [medline]
PHST- 2016/08/24 00:00 [pmc-release]
AID - openhrt-2016-000491 [pii]
AID - 10.1136/openhrt-2016-000491 [doi]
PST - epublish
SO  - Open Heart. 2016 Aug 24;3(2):e000491. doi: 10.1136/openhrt-2016-000491. 
      eCollection 2016.