Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection.
The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 ± 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis.
Department of Cardiology, Ospedale Carlo Poma, Mantova, Italy. Electronic address: corrado.lettieri@gmail.com.
Corrado
C
Lettieri
Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy.
Dennis
D
Zavalloni
Department of Cardiology, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Roberta
R
Rossini
Department of Cardiology, Ospedale Niguarda, Milano, Italy.
Nuccia
N
Morici
Department of Cardiology, Spedali Civili, Brescia, Italy.
Federica
F
Ettori
Department of Cardiology, Ospedale Poliambulanza, Brescia, Italy.
Ornella
O
Leonzi
Department of Cardiology, Istituto Scientifico San Raffaele, Milano, Italy.
Azeem
A
Latib
Department of Cardiology, Policlinico S. Matteo, Pavia, Italy.
Marco
M
Ferlini
Department of Cardiology, Centro Cardiologico Monzino, Milano, Italy.
Daniela
D
Trabattoni
Department of Cardiology, Ospedale Niguarda, Milano, Italy.
Paola
P
Colombo
Department of Cardiology, Ospedale S. Anna, Como, Italy.
Mario
M
Galli
Department of Cardiology, Università di Padova, Padova, Italy.
Giuseppe
G
Tarantini
Department of Cardiology, Università di Padova, Padova, Italy.
Massimo
M
Napodano
Department of Cardiology, Ospedale Luigi Sacco, Milano, Italy.
Emanuela
E
Piccaluga
Department of Cardiology, Istituti Ospitalieri, Cremona, Italy.
Enrico
E
Passamonti
Department of Cardiology, Ospedale di Treviglio Caravaggio, Treviglio, Italy.
Paolo
P
Sganzerla
Department of Cardiology, Ospedale Mater Domini, Castellanza Italy.
Alfonso
A
Ielasi
Department of Cardiology, Università di Padova, Padova, Italy.
Micol
M
Coccato
Department of Cardiology, Ospedale Fornaroli, Magenta, Italy.
Alessandro
A
Martinoni
Department of Cardiology, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Giuseppe
G
Musumeci
Department of Cardiology, Ospedale Carlo Poma, Mantova, Italy.
Roberto
R
Zanini
Department of Cardiology, Ospedale di Circolo, Varese, Italy.
Battistina
B
Castiglioni
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000151:congenital* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery