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Int J Cardiol. 2016 Mar 15;207:341-8. doi: 10.1016/j.ijcard.2016.01.188. Epub 2016 Jan 14.

Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan.

Author information

1
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
2
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
3
Division of Cardiology, Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
4
Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
5
Division of Cardiology, Kumamoto Central Hospital, Kumamoto, Japan.
6
Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
7
Department of Cardiology, Hyogo Brain and Heart Center, Himeji, Japan.
8
Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
9
Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
10
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
11
Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan.
12
Division of Cardiovascular Medicine, Sendai Cardiovascular Center, Sendai, Japan.
13
Nakada Internal Medicine Clinic, Saitama, Japan.
14
Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Mibu, Japan.
15
Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
16
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
17
Division of Cardiology, Department of Internal Medicine, Kinki University Faculty of Medicine, Sayama, Japan.
18
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Electronic address: yasuda.satoshi.hp@mail.ncvc.go.jp.

Abstract

BACKGROUND:

We sought to compare the prognosis of patients with spontaneous coronary artery dissection (SCAD) and atherosclerosis as the cause of acute myocardial infarction (AMI), especially in young females.

METHODS AND RESULTS:

A total of 20,195 patients with AMI at 20 institutions between 2000 and 2013 were retrospectively studied. Major adverse cardiac event (MACE: cardiac death, AMI or urgent revascularization) was the endpoint. The overall prevalence of SCAD was 0.31% (n=63; female, 94%). SCAD developed following emotional stress in 29% of patients. Revascularization was performed in 56% (35 of 63 patients), and SCAD recurrence developed in the originally involved vessel in 6 of 35 patients with revascularization, compared to none among 28 patients after conservative therapy (p=0.002). We compared the clinical characteristics of young female AMI patients aged ≤50years in the SCAD (n=45) and no-SCAD groups (atherosclerotic AMI, n=55). During a median follow-up of 50months, SCAD recurred in 27% of patients, of which 42% was in the first 30days. Kaplan-Meier analysis showed a significantly higher incidence of MACE in the SCAD group compared to the no-SCAD group (hazard ratio, 6.91; 95% confidence interval, 2.5 to 24.3; p<0.001), although the rate of successful percutaneous coronary intervention for SCAD was as high as 92%.

CONCLUSIONS:

Young female patients with SCAD represent a high-risk subgroup of patients with AMI and require close follow-up.

KEYWORDS:

Acute myocardial infarction; Prognosis; Spontaneous coronary artery dissection; Young woman

PMID:
26820364
DOI:
10.1016/j.ijcard.2016.01.188
[Indexed for MEDLINE]

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