Original title: Spontaneous Coronary Artery Dissection. Prevalence of Predisposing Conditions Including Fibromuscular Dysplasia in a Tertiary Center Cohort Reference: Jacqueline Saw, et al. J Am Coll Cardiol Intv 2013;6:44 –52
Non atherosclerotic spontaneous coronary artery dissection (Non atherosclerotic SCAD) is a rare disease that is associated with acute myocardial infarction and sudden death.
This condition is more common in women, having only 440 reported cases, but is likely to be underdiagnosed and therefore of much higher prevalence. The aim of the study was to evaluate the prevalence of fibro-muscular dysplasia (FMD) and other conditions predisposing to SCAD.
Angiograms were analyzed both retrospectively and prospectively between April 2006 and March 2012 in one center. To be considered as SCAD they must meet at least one of the following criteria: 1) multiple radiolucent lines separating the true and false, often retaining contrast, 2) long obstructions that compromise the middle or distal segments with abrupt demarcation in respect to the proximal segment and unresponsive to nitroglycerin, 3) intravascular imaging, (endoluminal ultrasound or optical coherence tomography), to demonstrate dissection. 50 patients were identified of which 49 were women (mean age 51 ± 9.6) and thin (BMI 23.4 ± 4) with low prevalence of cardiovascular risk factors except for hypertension (13%). The most relevant backgrounds were; postmeopausia 45%, migraine 27% or depression 29%.
All the patients were admitted for acute coronary syndrome with troponin elevation, (15 with ST segment elevation and 35 with non-ST elevation). The artery most frequently constrained was the DA (40%) followed by the circumflex artery and then the RC. In 88%, an isolated dissection was found, 4 patients had two separated dissections in the same artery and 2 patients had more than one artery affected. Angioplasty was performed in 7 patients and CABG in 2. All patients survived to hospital discharge.
We identified as potential triggers intense emotional stress situations, strong exercise before or during the episode and predisposing to pregnancy within one year or postpartum within 6 weeks. Fibro-muscular dysplasia screening was performed in other territories and dysplasia of the renal arteries was found in 25 patients, 21 patients in iliac arteries and 19 patients in brain arteries. 86% had dysplasia in more than one territory.
Conclusion
Non atherosclerotic SCAD predominantly affects women and is associated with fibro-muscular dysplasia in other territories.
Comment
It is important to investigate other territories to detect SCAD and take appropriate action to prevent complications.
Courtesy of Dr Carlos Fava.
Cardiólogo Intervencionista.
Fundación Favaloro. Argentina
Dr. Carlos Fava para SOLACI.ORG