PMID- 27727035
OWN - NLM
STAT- MEDLINE
DCOM- 20171102
LR  - 20171102
IS  - 0736-4679 (Print)
IS  - 0736-4679 (Linking)
VI  - 52
IP  - 3
DP  - 2017 Mar
TI  - Emergency Department Presentation of Patients with Spontaneous Coronary Artery
      Dissection.
PG  - 286-291
LID - S0736-4679(16)30716-8 [pii]
LID - 10.1016/j.jemermed.2016.09.005 [doi]
AB  - BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an infrequently
      recognized but potentially fatal cause of acute coronary syndrome (ACS) that
      disproportionately affects women. Little is currently known about how patients
      with SCAD initially present. OBJECTIVES: We sought to describe patients who
      presented to the emergency department (ED) with symptoms of SCAD to improve
      providers' awareness and recognition of this condition. PATIENTS AND METHODS: We 
      performed a retrospective medical record review of all patients who presented to 
      the ED of a single academic medical center from January 1, 2002 through October
      31, 2015 and were subsequently diagnosed with SCAD by angiography. These patients
      were identified by International Classification of Diseases, Ninth Revision codes
      and a Boolean search of the diagnosis field of the medical record. Data regarding
      patients' presentations and course were abstracted by two independent reviewers. 
      RESULTS: We identified 20 episodes of SCAD involving 19 patients, all of whom
      were female. The majority of patients had 0-1 conventional cardiovascular disease
      risk factors. Most patients had chest pain (85%), initial electrocardiograms
      without evidence of ischemia (85%), and elevated initial troponin (72%). The most
      common diagnosis in providers' differential was acute coronary syndrome (ACS).
      CONCLUSION: Patients with SCAD present with similar symptoms compared to patients
      with ACS caused by atherosclerotic disease, but have different risk profiles.
      Providers should consider SCAD in patients presenting with symptoms concerning
      for ACS, especially in younger female patients without traditional cardiovascular
      disease risk factors, as their risk may be significantly underestimated with
      commonly used ACS risk-stratifiers.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Lindor, Rachel A
AU  - Lindor RA
AD  - Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester,
      Minnesota.
FAU - Tweet, Marysia S
AU  - Tweet MS
AD  - Department of Cardiovascular Diseases, Mayo Clinic College of Medicine,
      Rochester, Minnesota.
FAU - Goyal, Kiran A
AU  - Goyal KA
AD  - Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester,
      Minnesota.
FAU - Lohse, Christine M
AU  - Lohse CM
AD  - Department of Health Sciences Research, Mayo Clinic College of Medicine,
      Rochester, Minnesota.
FAU - Gulati, Rajiv
AU  - Gulati R
AD  - Department of Cardiovascular Diseases, Mayo Clinic College of Medicine,
      Rochester, Minnesota.
FAU - Hayes, Sharonne N
AU  - Hayes SN
AD  - Department of Cardiovascular Diseases, Mayo Clinic College of Medicine,
      Rochester, Minnesota.
FAU - Sadosty, Annie T
AU  - Sadosty AT
AD  - Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester,
      Minnesota.
LA  - eng
PT  - Journal Article
DEP - 20161008
PL  - United States
TA  - J Emerg Med
JT  - The Journal of emergency medicine
JID - 8412174
RN  - Coronary Artery Dissection, Spontaneous
SB  - IM
MH  - Adult
MH  - Cardiovascular Diseases/complications
MH  - Chest Pain/etiology
MH  - Coronary Vessel Anomalies/*diagnosis/physiopathology
MH  - Coronary Vessels/*physiopathology
MH  - Emergency Service, Hospital/organization & administration
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Vascular Diseases/*congenital/diagnosis/physiopathology
OTO - NOTNLM
OT  - acute coronary syndrome
OT  - spontaneous coronary artery dissection
EDAT- 2016/10/12 06:00
MHDA- 2017/11/03 06:00
CRDT- 2016/10/12 06:00
PHST- 2016/05/18 00:00 [received]
PHST- 2016/08/03 00:00 [revised]
PHST- 2016/09/05 00:00 [accepted]
PHST- 2016/10/12 06:00 [pubmed]
PHST- 2017/11/03 06:00 [medline]
PHST- 2016/10/12 06:00 [entrez]
AID - S0736-4679(16)30716-8 [pii]
AID - 10.1016/j.jemermed.2016.09.005 [doi]
PST - ppublish
SO  - J Emerg Med. 2017 Mar;52(3):286-291. doi: 10.1016/j.jemermed.2016.09.005. Epub
      2016 Oct 8.