Spontaneous coronary artery dissection and ST-segment elevation myocardial infarction: Does clinical presentation matter?. (15th February 2023)

• Record Type: Journal Article
• Authors: García-Guimarães, Marcos; Sanz-Ruiz, Ricardo; Sabaté, Manel; Velázquez-Martín, Maite; Veiga, Gabriela; Ojeda, Soledad; Avanzas, Pablo; Cortés, Carlos; Trillo-Nouche, Ramiro; Pérez-Guerrero, Ainhoa; Gutiérrez-Barrios, Alejandro; Becerra-Muñoz, Víctor; Lozano-Ruiz-Poveda, Fernando; Pérez de Prado, Armando; del Val, David; Bastante, Teresa; Alfonso, Fernando
• Is Part Of: International journal of cardiology. Volume 373(2023)
• Page Start: 1
• Page End: 6
• Publication Date: 2023-02-15
• Subjects: Spontaneous coronary artery dissection -- Myocardial infarction -- Acute coronary syndrome; ACS acute coronary syndrome -- DAPT dual antiplatelet therapy -- EVA extra-coronary vascular abnormalities -- IMH intramural haematoma -- MACCE major adverse cardiovascular and cerebrovascular event -- MAE major adverse event -- NSTEMI non-ST-segment elevation myocardial infarction -- PCI percutaneous coronary intervention -- SCAD spontaneous coronary artery dissection -- SR-SCAD Spanish Registry on SCAD -- STEMI ST-segment elevation myocardial infarction -- TIMI Thrombolysis in Myocardial infarction; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.11.033
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Some patients with spontaneous coronary artery dissection (SCAD) present as ST-segment-elevation myocardial infarction (STEMI). This study evaluates the characteristics, management and outcomes of SCAD patients presenting as STEMI compared to non-ST-segment elevation myocardial infarction (NSTEMI). Methods: We analysed data from consecutive patients included in the prospective Spanish Registry on SCAD. All coronary angiograms were centrally reviewed. All adverse events were adjudicated by an independent Clinical Events Committee. Results: Between June 2015 to December 2020, 389 patients were included. Forty-two percent presented with STEMI and 56% with NSTEMI. STEMI patients showed a worse distal flow (TIMI flow 0–1 38% vs 19%, p < 0.001) and more severe (% diameter stenosis 85 ± 18 vs 75 ± 21, p < 0.001) and longer (42 ± 23 mm vs 35 ± 24 mm, p = 0.006) lesions. Patients with STEMI were more frequently treated with percutaneous coronary intervention (PCI) (31% vs 16%, p < 0.001) and developed more frequently left ventricular systolic dysfunction (21% vs 8%, p < 0.001). No differences were found in combined major adverse events during admission (7% vs 5%, p = 0.463), but in-hospital reinfarctions (5% vs 1.4%, p = 0.039) and cardiogenic shock (2.6% vs 0%, p = 0.019) were more frequently seen in the STEMI group. At late follow-up (median 29 months) no differences were found in the incidence of major adverse cardiac and cerebrovascular events (13% vs 13%, p -value = 0.882) between groups. Conclusions: Patients with SCAD and STEMI had a worse angiographic profile and were more frequently referred to PCI compared to NSTEMI patients. Despite these disparities, both short and long-term prognosis were similar in STEMI and NSTEMI SCAD patients. Highlights: In spontaneous coronary artery dissection (SCAD), patients presenting with STEMI showed a worse angiographic profile compared to NSTEMI. SCAD STEMI patients were more frequently treated with PCI, had larger infarcts with more left ventricular systolic dysfunction. In-hospital reinfarction and cardiogenic shock were more frequently seen in the STEMI SCAD group. Long-term prognosis after SCAD did not differ between STEMI and NSTEMI SCAD patients.