Spontaneous coronary artery dissection in old patients: clinical features, angiographic findings, management and outcome. Issue 8 (30th November 2020)

• Record Type: Journal Article
• Authors: Díez-Villanueva, Pablo; García-Guimaraes, Marcos; Sanz-Ruiz, Ricardo; Roura, Gerard; Macaya, Fernando; Barahona Alvarado, Jean Christophe; Tizón-Marcos, Helena; Flores-Ríos, Xacobe; Masotti, Mónica; Lezcano-Pertejo, Cristina; Cortés, Carlos; Fuertes-Ferre, Georgina; Becerra-Muñoz, Víctor Manuel; Lozano Ruiz-Poveda, Fernando; Valero, Ernesto; Portero-Portaz, Juan José; Vera, Alberto; Salamanca, Jorge; Alfonso, Fernando
• Is Part Of: European heart journal. Volume 10:Issue 8(2021)
• Page Start: 926
• Page End: 932
• Publication Date: 2020-11-30
• Subjects: Spontaneous coronary artery dissection -- Older patients -- Acute coronary syndrome -- Myocardial infarction; 616.1205
• DOI: 10.1093/ehjacc/zuaa029
• Languages: English
• ISSNs: 2048-8726

Abstract

Abstract: Aims: Spontaneous coronary artery dissection (SCAD) is a relatively rare but well-known cause of acute coronary syndrome. Clinical features, angiographic findings, management and outcomes of SCAD in old patients (>65 years of age) remain unknown. Methods and results: The Spanish multicentre prospective SCAD registry ( NCT03607981 ), included 318 consecutive patients with SCAD. Data were collected between June 2015 and April 2019. All angiograms were analysed in a centralized corelab. For the purposes of this study, patients were classified according to age in two groups <65 and ≥65 years old and in-hospital outcomes were analysed. Fifty-five patients (17%) were ≥65 years old (95% women). Older patients had more often hypertension (76% vs. 29%, P < 0.01) and dyslipidaemia (56% vs. 30%, P < 0.01), and less previous (4% vs. 18%, P < 0.001) or current smoking habit (4% vs. 33%, P < 0.001). An identifiable trigger was less often present in old patients (27% vs. 43%, P = 0.028). They also had more often severe coronary tortuosity (36% vs. 11%, P = 0.036) and showed more frequently coronary ectasia (24% vs. 9%, P < 0.01). Older patients were more often managed conservatively (89% vs. 75%, P = 0.025), with no significant differences in major adverse cardiac events during index admission (7% vs. 8%, P = 0.858). There were no differences between groups in terms of in-hospital stay, new acute myocardial infarction, unplanned coronary angiography or heart failure. Conclusion: Older patients with SCAD show different clinical and angiographic characteristics compared with younger patients. Initial treatment strategy was different between groups, though in-hospital outcomes do not significantly differ ( NCT03607981 ).