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Spontaneous coronary artery dissection and ST-segment elevation myocardial infarction: Does clinical presentation matter?

Published:November 23, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.11.033

      Highlights

      • In spontaneous coronary artery dissection (SCAD), patients presenting with ST-segment elevation myocardial infarction (STEMI) showed a worse angiographic profile (with worse initial distal flow and more severe and longer lesions) compared to NSTEMI.
      • SCAD STEMI patients were more frequently treated with percutaneous coronary intervention and had larger infarcts with more left ventricular systolic dysfunction.
      • In-hospital reinfarction and cardiogenic shock were more frequently seen in the STEMI SCAD group.
      • Long-term prognosis after SCAD did not differ between STEMI and NSTEMI SCAD patients.

      Abstract

      Background

      Some patients with spontaneous coronary artery dissection (SCAD) present as ST-segment-elevation myocardial infarction (STEMI). This study evaluates the characteristics, management and outcomes of SCAD patients presenting as STEMI compared to non-ST-segment elevation myocardial infarction (NSTEMI).

      Methods

      We analysed data from consecutive patients included in the prospective Spanish Registry on SCAD. All coronary angiograms were centrally reviewed. All adverse events were adjudicated by an independent Clinical Events Committee.

      Results

      Between June 2015 to December 2020, 389 patients were included. Forty-two percent presented with STEMI and 56% with NSTEMI. STEMI patients showed a worse distal flow (TIMI flow 0–1 38% vs 19%, p < 0.001) and more severe (% diameter stenosis 85 ± 18 vs 75 ± 21, p < 0.001) and longer (42 ± 23 mm vs 35 ± 24 mm, p = 0.006) lesions. Patients with STEMI were more frequently treated with percutaneous coronary intervention (PCI) (31% vs 16%, p < 0.001) and developed more frequently left ventricular systolic dysfunction (21% vs 8%, p < 0.001). No differences were found in combined major adverse events during admission (7% vs 5%, p = 0.463), but in-hospital reinfarctions (5% vs 1.4%, p = 0.039) and cardiogenic shock (2.6% vs 0%, p = 0.019) were more frequently seen in the STEMI group. At late follow-up (median 29 months) no differences were found in the incidence of major adverse cardiac and cerebrovascular events (13% vs 13%, p-value = 0.882) between groups.

      Conclusions

      Patients with SCAD and STEMI had a worse angiographic profile and were more frequently referred to PCI compared to NSTEMI patients. Despite these disparities, both short and long-term prognosis were similar in STEMI and NSTEMI SCAD patients.

      Keywords

      Abbreviations:

      ACS (acute coronary syndrome), DAPT (dual antiplatelet therapy), EVA (extra-coronary vascular abnormalities), IMH (intramural haematoma), MACCE (major adverse cardiovascular and cerebrovascular event), MAE (major adverse event), NSTEMI (non-ST-segment elevation myocardial infarction), PCI (percutaneous coronary intervention), SCAD (spontaneous coronary artery dissection), SR-SCAD (Spanish Registry on SCAD), STEMI (ST-segment elevation myocardial infarction), TIMI (Thrombolysis in Myocardial infarction)
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