Coronary Artery Dissection in Women: Rare and Difficult to Manage

Courtesy of  Dr. Carlos Fava.

Spontaneous Coronary artery dissection (SCAD) was first described in 1931 and, even though its prevalence according to different studies is roughly between 0.07% and 1.1%, it is more frequent in women and is associated to acute coronary syndrome and sudden death.

The study looked at 752,352 women presenting acute myocardial infarction (AMI) between 2009 and 2014: 7,347 (0.98%) presenting SCAD and 3296 presenting ST elevation AMI.

Read also: “Women: More Prone to Lower Coronary Flow Reserve”.

Those presenting SCAD were younger (61 vs. 67 years) and exhibited less coronary risk factors.

In hospital death was higher in the SCAD group (6.8% vs. 3.4% p<0.0001). However, mortality decreased with time (11% in 2009 and 5% in 2014), which was associated to lower left main PC intervention procedures (82.5% vs. 69.1%).

Read also: “Sex Specific Outcomes: Women after TAVI”.

Propensity score matching was carried out to adjust for differences. This did not change in-hospital mortality, which continued to be higher in the SCAD group (6.8% vs 3.8% p<0.0001). Mortality was associated to older age (>62), hypertension, left main PCI and non-ST elevation MI (not with STEMI).

Conclusion

Women presenting MI and SCAD seem at higher mortality risk. Lower PCI rate was associated to better survival with worse evolution when PCI was performed to treat SCAD in non-STEMI patients.

Comment

This is the largest series published so far on this phenomenon and, rare as it may be, which we should be aware of it to be able to make well informed decisions.

This analysis shows that we should perform PCI only in case of ST elevation MI, since otherwise it is associated with higher mortality and therefore it would be counterproductive. However, in order to make the right decision, we should also identify where the dissection is and assess flow.

Courtesy of Dr. Carlos Fava.

Título original: Trends of Incidence, Clinical Presentation and In-Hospital Among Women With Acute Myocardial Infarction With or Without Spontaneous  Coronary Artery Dissection. A Population-Based Analysis.

Referencia: Ahmed N Mahmoud, et al. JACC Cardiov Intev 2018; 11:80-90

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