SPC365

SPONTANEOUS CORONARY ARTERY DISSECTION - TEN YEARS EXPERIENCE OF A TERCIARY CENTER-

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Tânia Proença

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.6 Acute Coronary Syndromes - Clinical
Session Type: Posters
FP Number: ---
Authors: Tânia Proença; Miguel Martins Carvalho; Ricardo Alves Pinto; Sofia Torres; Carlos Xavier Resende; Pedro Diogo Grilo; Filipa Amador; Catarina Costa; João Calvão; Marta Tavares Silva; Roberto Pinto; Paula Dias; Filipe Macedo

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#333333">Background:&nbsp;</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#333333"> Spontaneous coronary artery dissection (SCAD) represents 1 to 4% of all acute coronary syndromes (ACS) and is an important cause of myocardial infarction particularly among young women and individuals with few cardiovascular risk factors. Due to its misdiagnosis and underdiagnosis, literature concerning to the best management is scarce. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#333333">Purpose:</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#333333"> To characterize clinical background, therapeutic management and clinical outcomes in a SCAD population. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#333333">Methods: </span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#333333">We retrospectively analyzed all patients diagnosed with SCAD at a tertiary center from August 2009 to December 2019. Clinical, angiographic, and imagological data were collected at admission, and a median follow-up of 49 months.</span></span> All coronary angiographies were reviewed and Saw angiographic SCAD classification was applied. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#333333">Results: </span></span></span></strong>&nbsp;<span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#333333">35 patients were included, 94% were female (45% post-menopausal and one patient was pregnant), with a mean age of 52 </span></span><span style="color:#333333">&plusmn;<span style="font-family:&quot;Calibri&quot;,sans-serif"> 11 years. Concerning </span>cardiovascular risk factors,<span style="font-family:&quot;Calibri&quot;,sans-serif"> 49% had hypertension, 40% had dyslipidemia, 6% had diabetes and 31% were smokers or previous smokers. </span></span>Trigger was only detected in 6% of patients and associated conditions in 29% (3 cases of inflammatory systemic disease, 3 of migraine, 2 of autoimmune disease and 2 in hormonal therapy). <span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#333333">37% presented with ST-elevation myocardial infarction (STEMI), 60% with non-ST-</span></span>elevation acute coronary syndrome (NST-ACS) and one patient were diagnosed incidentally. The most affected vessel was anterior descendent artery (65%) followed by circumflex artery (23%); the majority of cases affected mid to distal segments (89%), 2 cases affected left main coronary artery, and 11% of dissections were multivessel; type 2 was the most prevalent dissection (60%), and no type 3 was detected; only 4 patients were submitted to percutaneous intervention. Overall, 24% of patients had recurrence of pain, 35% repeat coronary angiography during hospitalization (54% with progression of dissection). At discharge, 89% of patients were medicated with double anti-platelet therapy, 77% with statin, 77% with beta-blocker and 57% with inhibitors of renin&ndash;angiotensin system. A stress test was performed in 63% of patients in the follow up, with 91% being negative; 23% repeated coronary angiography (both control or suspected ischaemic event), with 75% showing imagological improvement. Concerning to recurrence, 20% had chest pain and 17% had a new ischaemic event (all NST-ACS). No patient died during the <span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#333333">median follow-up of 49 months.</span></span></span>&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-size:10.0pt">Conclusion</span></strong><span style="font-size:10.0pt">: In our study, as describe in the literature, left anterior descending artery and mid-distal segments were the most affected, and type 2 dissection was the most prevalent. Conservative approach was the preferred therapeutic method; however, SCAD remains not only a diagnostic but also a therapeutic challenge and frequently patients are treated as those with atherosclerotic ACS.&nbsp; </span></span></span></p>