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PMID- 28838364
OWN - NLM
STAT- In-Process
DA  - 20170825
LR  - 20170825
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 70
IP  - 9
DP  - 2017 Aug 29
TI  - Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence.
PG  - 1148-1158
LID - S0735-1097(17)37997-4 [pii]
LID - 10.1016/j.jacc.2017.06.053 [doi]
AB  - BACKGROUND: Spontaneous coronary artery dissection (SCAD) is underdiagnosed and
      an important cause of myocardial infarction (MI), especially in young women.
      Long-term cardiovascular outcomes, including recurrent SCAD, are inadequately
      reported. OBJECTIVES: This study sought to describe the acute and long-term
      cardiovascular outcomes and assess the predictors of recurrent SCAD. METHODS:
      Nonatherosclerotic SCAD patients were prospectively followed at Vancouver General
      Hospital systematically to ascertain baseline, predisposing and precipitating
      stressors, angiographic features, revascularization, use of medication, and
      in-hospital and long-term cardiovascular events. Clinical predictors for
      recurrent de novo SCAD were tested using univariate and multivariate Cox
      regression models. RESULTS: The authors prospectively followed 327 SCAD patients.
      Average age was 52.5 +/- 9.6 years, and 90.5% were women (56.9% postmenopausal). 
      All presented with MI; 25.7% had ST-segment elevation MI, 74.3% had
      non-ST-segment elevation MI, and 8.9% had ventricular tachycardia/ventricular
      fibrillation. Precipitating emotional stressors were reported in 48.3% and
      physical stressors in 28.1%. Fibromuscular dysplasia was present in 62.7%,
      connective tissue disorder in 4.9%, and systemic inflammatory disease in 11.9%.
      The majority (83.1%) were initially treated medically, with only 16.5% or 2.2%
      undergoing in-hospital percutaneous coronary intervention or coronary artery
      bypass graft surgery, respectively. The majority of SCAD patients were taking
      aspirin and beta-blocker therapy at discharge and at follow-up. Median hospital
      stay was 3.0 days, and the overall major adverse event rate was 7.3%. Median
      long-term follow-up was 3.1 years, and overall major adverse cardiac event rate
      was 19.9% (death rate: 1.2%; recurrent MI: 16.8%; stroke/transient ischemic
      attack: 1.2%; revascularization: 5.8%). Recurrent SCAD occurred in 10.4% of
      patients. In multivariate modeling, only hypertension increased (hazard ratio:
      2.46; p = 0.011) and beta-blocker use diminished (hazard ratio: 0.36; p = 0.004) 
      recurrent SCAD. CONCLUSIONS: In our large prospectively followed SCAD cohort,
      long-term cardiovascular events were common. Hypertension increased the risk of
      recurrent SCAD, whereas beta-blocker therapy appeared to be protective.
CI  - Copyright (c) 2017 American College of Cardiology Foundation. Published by
      Elsevier Inc. All rights reserved.
FAU - Saw, Jacqueline
AU  - Saw J
AD  - Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, 
      Canada. Electronic address: [email protected]
FAU - Humphries, Karin
AU  - Humphries K
AD  - British Columbia Centre for Improved Cardiovascular Health, University of British
      Columbia, Vancouver, British Columbia, Canada.
FAU - Aymong, Eve
AU  - Aymong E
AD  - Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
FAU - Sedlak, Tara
AU  - Sedlak T
AD  - Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, 
      Canada.
FAU - Prakash, Roshan
AU  - Prakash R
AD  - Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, 
      Canada.
FAU - Starovoytov, Andrew
AU  - Starovoytov A
AD  - Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, 
      Canada.
FAU - Mancini, G B John
AU  - Mancini GBJ
AD  - Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, 
      Canada.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
OTO - NOTNLM
OT  - beta-blocker
OT  - coronary angiography
OT  - fibromuscular dysplasia
OT  - hypertension
OT  - myocardial infarction
OT  - women
EDAT- 2017/08/26 06:00
MHDA- 2017/08/26 06:00
CRDT- 2017/08/26 06:00
PHST- 2017/05/08 [received]
PHST- 2017/06/23 [revised]
PHST- 2017/06/26 [accepted]
AID - S0735-1097(17)37997-4 [pii]
AID - 10.1016/j.jacc.2017.06.053 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2017 Aug 29;70(9):1148-1158. doi: 10.1016/j.jacc.2017.06.053.