title: Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan.
abstract: BACKGROUND
  We sought to compare the prognosis of patients with spontaneous coronary artery dissection (SCAD) and atherosclerosis as the cause of acute myocardial infarction (AMI), especially in young females.
  
  
  RESULTS
  A total of 20,195 patients with AMI at 20 institutions between 2000 and 2013 were retrospectively studied. Major adverse cardiac event (MACE: cardiac death, AMI or urgent revascularization) was the endpoint. The overall prevalence of SCAD was 0.31% (n=63; female, 94%). SCAD developed following emotional stress in 29% of patients. Revascularization was performed in 56% (35 of 63 patients), and SCAD recurrence developed in the originally involved vessel in 6 of 35 patients with revascularization, compared to none among 28 patients after conservative therapy (p=0.002). We compared the clinical characteristics of young female AMI patients aged ≤50years in the SCAD (n=45) and no-SCAD groups (atherosclerotic AMI, n=55). During a median follow-up of 50months, SCAD recurred in 27% of patients, of which 42% was in the first 30days. Kaplan-Meier analysis showed a significantly higher incidence of MACE in the SCAD group compared to the no-SCAD group (hazard ratio, 6.91; 95% confidence interval, 2.5 to 24.3; p<0.001), although the rate of successful percutaneous coronary intervention for SCAD was as high as 92%.
  
  
  CONCLUSIONS
  Young female patients with SCAD represent a high-risk subgroup of patients with AMI and require close follow-up.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakashima
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Noguchi
authors.affiliation: Division of Cardiology, Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Haruta
authors.affiliation: Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Division of Cardiology, Kumamoto Central Hospital, Kumamoto, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Oshima
authors.affiliation: Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakao
authors.affiliation: Department of Cardiology, Hyogo Brain and Heart Center, Himeji, Japan.
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Taniguchi
authors.affiliation: Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Yamaguchi
authors.affiliation: Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Tsuchihashi
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seki
authors.affiliation: Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kawasaki
authors.affiliation: Division of Cardiovascular Medicine, Sendai Cardiovascular Center, Sendai, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Uchida
authors.affiliation: Nakada Internal Medicine Clinic, Saitama, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Omura
authors.affiliation: Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Mibu, Japan.
authors.forename: Migaku
authors.initials: M
authors.lastname: Kikuchi
authors.affiliation: Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kinki University Faculty of Medicine, Sayama, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Electronic address: yasuda.satoshi.hp@mail.ncvc.go.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D003330:Coronary Vessel Anomalies / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology*; D011379:Prognosis; D058028:Research Report; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000151:congenital* / Q000175:diagnosis / Q000453:epidemiology
keywords: Acute myocardial infarction; Prognosis; Spontaneous coronary artery dissection; Young woman