Risks and benefits of percutaneous coronary intervention in spontaneous coronary artery dissection

To investigate percutaneous coronary intervention (PCI) practice in an international cohort of patients with spontaneous coronary artery dissection (SCAD). To explore factors associated with complications and study angiographic and longer term outcomes. SCAD patients (n=215, 94% female) who underwen...

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Detalles Bibliográficos
Autores: Kotecha, Deevia, García-Guimaraes, Marcos|||0000-0001-8509-6184, Premawardhana, Diluka, Pellegrini, Dario|||0000-0002-5545-585X, Oliver-Williams, Clare, Bountziouka, Vasiliki, Wood, Alice, Natarajan, Nalin, Jackson, Robert, Chan, Nathan, Ziaullah, Jan, Rakhit, Roby D., Hoole, Stephen P., Johnson, Tom W., Kadziela, Jacek, Ludman, Peter|||0000-0002-7237-0946, Samani, Nilesh J., Maas, Angela H. E. M., van Geuns, Robert-Jan|||0000-0003-2943-5932, Alfonso, Fernando|||0000-0002-7480-2511, Adlam, David|||0000-0002-0080-9884
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:249094
Acceso en línea:https://ddd.uab.cat/record/249094
https://dx.doi.org/urn:doi:10.1136/heartjnl-2020-318914
Access Level:acceso abierto
Palabra clave:Percutaneous coronary intervention
Acute coronary syndrome
Descripción
Sumario:To investigate percutaneous coronary intervention (PCI) practice in an international cohort of patients with spontaneous coronary artery dissection (SCAD). To explore factors associated with complications and study angiographic and longer term outcomes. SCAD patients (n=215, 94% female) who underwent PCI from three national cohort studies were investigated and compared with a matched cohort of conservatively managed SCAD patients (n=221). SCAD-PCI patients were high risk at presentation with only 8.8% undergoing PCI outside the context of ST-elevation myocardial infarction/cardiac arrest, thrombolysis in myocardial infarction (TIMI) 0/1 flow or proximal dissections. PCI complications occurred in 38.6% (83/215), with 13.0% (28/215) serious complications. PCI-related complications were associated with more extensive dissections (multiple vs single American Heart Association coronary segments, OR 1.9 (95% CI: 1.06-3.39), p=0.030), more proximal dissections (proximal diameter per mm, OR 2.25 (1.38-3.67), p=0.001) and dissections with no contrast penetration of the false lumen (Yip-Saw 2 versus 1, OR 2.89 (1.12-7.43), p=0.028). SCAD-PCI involved long lengths of stent (median 46mm, IQR: 29-61mm). Despite these risks, SCAD-PCI led to angiographic improvements in those with reduced TIMI flow in 84.3% (118/140). Worsening TIMI flow was only seen in 7.0% (15/215) of SCAD-PCI patients. Post-PCI major adverse cardiovascular and cerebrovascular events (MACCE) and left ventricular function outcomes were favourable. While a conservative approach to revascularisation is favoured, SCAD cases with higher risk presentations may require PCI. SCAD-PCI is associated with longer stent lengths and a higher risk of complications but leads to overall improvements in coronary flow and good medium-term outcomes in patients.

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