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Spontaneous coronary artery dissection: a 5-year review from a tertiary care center
Session:
Posters (Sessão 3 - Écran 2) - Enfarte Agudo do Miocárdio 2
Speaker:
Luís Santos
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Luís Santos; Ana Pinho; Cátia Oliveira; Catarina Marques; André Cabrita; Catarina Costa; Ana Amador; João Calvão; Tânia Proença; Ricardo Pinto; Miguel Carvalho; Elisabete Martins; Filipe Macedo
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) overall (1-4%), however it may account for 25-33% of ACS in women under 50 years old. It is characterized by the formation of an intramural hematoma with occlusion of the artery lumen by the hematoma itself or a dissection flap. Potential predisposing factors include fibromuscular dysplasia (FMD), postpartum status, multiparity (≥4 births), connective tissue disorders, systemic inflammatory conditions, and hormonal therapy. Diagnosis is established based on coronary angiography and management is usually conservative. Despite advances in the angiography field, it is still a poorly studied condition with a severe lack of prospective studies. In this study we describe the cases of SCAD in a tertiary care center over the last 5 years.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We retrospectively analyzed all patients diagnosed with SCAD at a tertiary center from January 2018 to December 2022. Clinical, angiographic, and imagiological data were collected at admission, and at an average follow-up of 20 months.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">There was a total of 24 patients included, 23 of which were female (96%) with only one male; average age was 54 years. The most common cardiovascular risk factor was Hypertension (54%), followed by Dyslipidemia (42%) and Smoking (17%). Type 2 dissection was the most common (59%) and the most commonly affected vessel was the anterior descending artery. Only one patient had multivessel involvment (left common + anterior descending + circunflex). Most patients presented as NSTEMI (70%) or STEMI (25%) with one patient presenting as Unstable Angina; average peak Troponin level was 46.000ng/L. Most patients remained in Killip I (87%), with 75% having a preserved ejection fraction on echocardiogram. One patient however developed an interventricular septum defect, underwent cardiac surgery and died in the post-op period. 8 patients (33%) performed a cardiac stress test during hospitalization or the follow up period, with only 1 of them showing residual ischemia. 88% of the patients remained symptom free during the follow-up period. One patient had a STEMI roughly 3 years after SCAD. One patient had a previous diagnosis of Fybromuscular Dysplasia and another was diagnosed with this condition after finding a cerebral aneurysm on head-CT.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Findings in our study were similar to those found in literature. SCAD still remains a diagnostic and therapeutic challenge for cardiologists nowadays.</span></span></p>
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