Score System Approach to Diagnose and Manage Spontaneous Coronary Artery Dissection. Response (original) (raw)
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Risk Factors, Imaging Findings, and Sex Differences in Spontaneous Coronary Artery Dissection
The American Journal of Cardiology, 2019
Spontaneous coronary artery dissection (SCAD) is increasingly being recognized. However, data supporting diagnosis and management are scarce. We analyze a contemporary and comprehensive SCAD registry to advance the understanding of SCAD risk factors, angiographic appearance, and gender differences. This is a retrospective analysis of a prospectively populated database of SCAD patients seen at the Massachusetts General Hospital (MGH) between June 2013 and October 2017. Core laboratory analysis of both coronary angiograms and computerized tomographic (CT) angiography of the extracoronary vessels was performed. Of the 113 patients, 87% were female and mean age was 47 § 10 years. Traditional cardiovascular risk factors including hypertension, hyperlipidemia, and smoking were present in 27%, 14%, and 22% of patients. Among females, 14%, 8%, and 9% had a history of gestational hypertension, pre-eclampsia, and gestational diabetes, respectively. Fifteen percent had used fertility treatment and 47% of postmenopausal women had used hormone replacement therapy. Angiography showed multivessel SCAD in 42%, severe coronary artery tortuosity in 59%, and extracoronary vascular abnormalities in 100% of patients with complete CT angiographic imaging. Gender differences revealed a self-reported depression and anxiety prevalence of 20% and 32%, respectively, in women compared with 0% in men. Type 1 SCAD was more commonly diagnosed in men than women (71% vs 29%, p <0.01). In conclusion, we highlight under-recognized features of SCAD including (1) relation with pregnancy complications and exposure to hormonal therapy; (2) diffuse, multivessel process in tortuous coronaries on a background of extracoronary arterial abnormalities; and (3) gender differences highlighting the role of mental health as well as potential underdiagnoses in men.
Insights into Imaging
Background The coronary artery disease reporting and data system (CAD-RADS) is designed for a uniform standardization of coronary computed tomography angiography (CCTA) reporting and further management recommendations of coronary artery disease (CAD). This study aimed to assess clinical validity, applicability, and reproducibility of CAD-RADS in the management of patients with CAD. Methods and results A single-center prospective study included 287 patients with clinically suspected or operated CAD who underwent CCTA. Four reviewers evaluated the CCTA images independently and assigned a CAD-RADS category to each patient. The invasive coronary angiography (ICA) was used as the reference standard for calculating diagnostic performance of CAD-RADS for categorizing the degree of coronary artery stenosis. The intra-class correlation (ICC) was used to test the inter-reviewer agreement (IRA). Reporting was provided to referring consultants according to the CAD-RADS. Based on ICA results, we...
Journal of the American College of Cardiology, 2014
S pontaneous coronary artery dissection (SCAD) is considered a rare condition, but the true prevalence in the overall population is unknown. It has been reported to be an infrequent cause of acute coronary syndrome (0.1%-4%) 1,2 and sudden cardiac death (0.4%). To date, <800 cases have been reported in the literature since the first autopsy report in 1931. 4 This is a clear under-representation of this disease, mostly because of the challenges of conventional coronary angiography in diagnosing SCAD. In addition, there is disparate sex and age predisposition according to the cause of SCAD. SCAD is broadly classified into atherosclerotic and nonatherosclerotic (NA) causes, which affect dissimilar populations with different risks and angiographic characteristics. NA-SCAD is distinct in that younger women are affected, especially those without (or low incidence of) cardiovascular risk factors. In our review of young women aged ≤50 years undergoing coronary angiography, we found that SCAD was the cause of myocardial infarction (MI) in 24% of cases. 5 Thus, in the select population of younger women presenting with MI, SCAD is not rare.
JACC. Cardiovascular imaging, 2016
The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient...
European Journal of Cardio-Thoracic Surgery, 2009
Objective: To assess the prevalence, clinical presentation, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection (SCAD). Methods: Over a 5-year period, and out of a cath-lab database of 11,605 files, 23 cases of SCAD were confirmed by reanalysis of angiograms. Therapeutic management and in-hospital outcome were obtained from medical files and prospective follow-up was performed. Results: The population consisted of 17 women and 6 men (mean age 45 years). A total of 83% of men had !2 cardiovascular risk factors versus only 35% of women ( p = 0.07). Acute coronary syndrome (ACS) was the clinical presentation in 21 cases (ST+ 61%). The prevalence of SCAD was: 0.2% in the whole population (men: 0.07%, women: 0.6%, p < 0.001), and 8.7% and 10.8% in women <50 years with ACS and ST+ ACS, respectively. Left and right coronary arteries were involved in 20 (87%) and 3 (13%) cases, respectively. Coronary stenting alone was performed in 8 (35%), bypass surgery alone in 2 (9%), and both in 3 (13%) cases. Ten patients (44%) were medically managed. One patient died during hospitalization. At 1-year follow-up (100%), 77% of discharged patients were event-free. One patient died, four experienced heart failure, and none had angina or new ACS. Conclusion: SCAD is observed in as much as 1 out 10 women <50 years presenting with ACS. After immediate coronary angiography, medical therapy is the chosen strategy in half of cases. Most patients who survive the acute phase are free from coronary events at 1 year. #