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Am J Cardiol. 2015 Jul 1;116(1):66-73. doi: 10.1016/j.amjcard.2015.03.039. Epub 2015 Apr 8.

Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection.

Author information

1
Department of Cardiology, Ospedale Carlo Poma, Mantova, Italy. Electronic address: corrado.lettieri@gmail.com.
2
Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy.
3
Department of Cardiology, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
4
Department of Cardiology, Ospedale Niguarda, Milano, Italy.
5
Department of Cardiology, Spedali Civili, Brescia, Italy.
6
Department of Cardiology, Ospedale Poliambulanza, Brescia, Italy.
7
Department of Cardiology, Istituto Scientifico San Raffaele, Milano, Italy.
8
Department of Cardiology, Policlinico S. Matteo, Pavia, Italy.
9
Department of Cardiology, Centro Cardiologico Monzino, Milano, Italy.
10
Department of Cardiology, Ospedale S. Anna, Como, Italy.
11
Department of Cardiology, Università di Padova, Padova, Italy.
12
Department of Cardiology, Ospedale Luigi Sacco, Milano, Italy.
13
Department of Cardiology, Istituti Ospitalieri, Cremona, Italy.
14
Department of Cardiology, Ospedale di Treviglio Caravaggio, Treviglio, Italy.
15
Department of Cardiology, Ospedale Mater Domini, Castellanza Italy.
16
Department of Cardiology, Ospedale Fornaroli, Magenta, Italy.
17
Department of Cardiology, Ospedale Carlo Poma, Mantova, Italy.
18
Department of Cardiology, Ospedale di Circolo, Varese, Italy.

Abstract

The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 ± 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis.

PMID:
25937347
DOI:
10.1016/j.amjcard.2015.03.039
[Indexed for MEDLINE]

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