Spontaneous coronary artery dissection: prevalence of predisposing conditions including fibromuscular dysplasia in a tertiary center cohort.
نویسندگان
چکیده
OBJECTIVES We sought to evaluate the prevalence of fibromuscular dysplasia (FMD) and other predisposing conditions among spontaneous coronary artery dissection (SCAD) patients. BACKGROUND Spontaneous coronary artery dissection is considered rare. However, we observed many young women with SCAD and concomitant FMD. METHODS Spontaneous coronary artery dissection patients were identified prospectively and retrospectively at Vancouver General Hospital over the past 6 years. Coronary angiograms were meticulously reviewed by 2 senior interventional cardiologists. Identified patients were contacted for prospective evaluation at our SCAD clinic, and screening for FMD of renal, iliac, and cerebrovascular arteries was performed with computed tomography angiography or magnetic resonance angiography, if not already screened during the index angiogram. Potential predisposing and precipitating conditions for SCAD were extracted from clinical history. RESULTS We identified 50 patients with nonatherosclerotic SCAD from April 2006 to March 2012. Average age was 51.0 years, and almost all were women (98.0%). All presented with myocardial infarction (MI), 30.0% had ST-segment elevation, and 70.0% had non-ST-segment elevation MI. Only 1 was postpartum, and 2 were involved in intense isometric exercises. Emotional stress was reported in 26.0% before the MI. Twelve percent had >1 dissected coronary artery. Most SCAD patients had FMD of ≥1 noncoronary territory (86.0%): 25 of 43 (58.1%) renal, 21 of 43 (48.8%) iliac, and 20 of 43 (46.5%) cerebrovascular (6 of 43, 14.0% had intracranial aneurysm). Five had incomplete FMD screening. CONCLUSIONS Nonatherosclerotic SCAD predominantly affects women, and most have concomitant FMD. We suspect these patients have underlying coronary FMD that predisposed them to SCAD, but this requires proof from histology or intracoronary imaging of the affected coronary arteries.
منابع مشابه
Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes.
BACKGROUND Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described. METHODS AND RESULTS Patients with NA-SCAD prospectively evaluated (retrospectively or prospectively identified) at Vancou...
متن کاملFibromuscular Dysplasia Leading to Spontaneous Coronary Artery Dissection with Sudden Cardiac Arrest
A 30-year-old previously healthy female, who was six-week postpartum, experienced sudden collapse and tonic-clonic seizure. Emergency medicine services arrived at the scene and the patient was found to be in ventricular fibrillation. Advanced cardiovascular life support (ACLS) was initiated with return of spontaneous circulation. Afterwards, her initial EKG showed atrial fibrillation with rapid...
متن کاملSix-Vessel Spontaneous Coronary Artery Dissection and Vertebral Artery Dissection in Fibromuscular Dysplasia
Fibromuscular dysplasia is a non-inflammatory and non-atherosclerotic arteriopathy commonly affecting medium-size renal, carotid, and vertebral arteries. Involvement of the coronary artery is very rare but may cause life-threatening spontaneous dissection. Because it is rare, this disease may go unrecognized. A unique angiographic finding of non-coronary arteries can make an early diagnosis, an...
متن کاملSpontaneous coronary artery dissection in patients with fibromuscular dysplasia: a case series.
Young women with acute coronary syndrome (ACS) frequently have nonatherosclerotic coronary artery disease (NACAD) and may be misdiagnosed. Coronary fibromuscular dysplasia (CFMD) commonly is overlooked, as the angiographic appearance is often subtle. Our group previously described CFMD as a diffuse obliterative disease starting abruptly at the mid-distal vessel, involving long segments.1 Sponta...
متن کاملFibromuscular Dysplasia Presenting as Spontaneous Coronary Artery Dissection
Submit Manuscript | http://medcraveonline.com with a Troponin-I of 26 ng/ml. Emergent left heart catheterization was performed and did not reveal any obstructive coronary artery disease, yet the ostium of the right coronary was thought to have spasm and non-selective injection was performed without revealing any obvious abnormality. Hence, a Computerized Tomography (CT) aortography of the chest...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- JACC. Cardiovascular interventions
دوره 6 1 شماره
صفحات -
تاریخ انتشار 2013