Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction

Angie S. Lobo; Stephanie M. Cantu; Scott W. Sharkey; Elizabeth Z. Grey; Katelyn Storey; Dawn Witt; Gretchen Benson; Ross F. Garberich; Yasuhiko Kubota; C. Noel Bairey Merz; Timothy D. Henry

doi:10.1016/j.jacc.2019.06.065

Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction

Angie S. Lobo
, Stephanie M. Cantu
, Scott W. Sharkey
, Elizabeth Z. Grey
, Katelyn Storey
, Dawn Witt
, Gretchen Benson
, Ross F. Garberich
, Yasuhiko Kubota
, C. Noel Bairey Merz
, Timothy D. Henry

Medicine - Cardiology Division

Research output: Contribution to journal › Article › peer-review

97 Scopus citations

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction (MI) in younger women, often treated conservatively due to revascularization risks. Revascularization outcomes are largely unknown in SCAD presenting with ST-segment elevation myocardial infarction (STEMI). Objectives: The purpose of this study was to compare revascularization strategies and outcomes of STEMI-SCAD with STEMI atherosclerosis (STEMI-ATH). Methods: Consecutive STEMI patients were retrospectively analyzed (2003 to 2017) at 2 regional STEMI programs (Minneapolis Heart Institute and Cedars-Sinai Smidt Heart Institute) with 3-year outcomes. Results: Among 5,208 STEMI patients, SCAD was present in 53 (1%; 93% female). SCAD prevalence was 19% in female STEMI patients age ≤50 years. Compared with STEMI-ATH, STEMI-SCAD patients were younger (age 49 ± 10 years vs. 63 ± 13 years), were more often female (93% vs. 27%), and had more frequent cardiogenic shock (19% vs. 9%); all p ≤ 0.03. In STEMI-SCAD, the culprit artery was more commonly left main (13% vs. 1%) or left anterior descending (47% vs. 38%); both p = 0.003. Acute revascularization was lower in STEMI-SCAD (70% vs. 97%); p < 0.001. In STEMI-SCAD, acute revascularization included percutaneous coronary intervention (PCI), n = 33 (62%), or bypass grafting, n = 4 (8%); PCI success was 91%. Those with revascularization were more likely to have shock, left main culprit, proximal dissection, and initial TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to 1. The 3-year survival was 98% for STEMI-SCAD versus 84% for STEMI-ATH; p < 0.001. Conclusions: STEMI-SCAD represents an important STEMI subset, particularly among younger women, characterized by significantly greater frequency of left main or left anterior descending culprit and cardiogenic shock than STEMI-ATH. Primary PCI is successful in most STEMI-SCAD patients, with low 3-year mortality.

Original language	English (US)
Pages (from-to)	1290-1300
Number of pages	11
Journal	Journal of the American College of Cardiology
Volume	74
Issue number	10
DOIs	https://doi.org/10.1016/j.jacc.2019.06.065
State	Published - Sep 10 2019

Bibliographical note

Publisher Copyright:
© 2019 American College of Cardiology Foundation

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SDG 3 Good Health and Well-being

Keywords

SCAD
STEMI
cardiogenic shock
left main dissection
women

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10.1016/j.jacc.2019.06.065

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Lobo, A. S., Cantu, S. M., Sharkey, S. W., Grey, E. Z., Storey, K., Witt, D., Benson, G., Garberich, R. F., Kubota, Y., Bairey Merz, C. N., & Henry, T. D. (2019). Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction. Journal of the American College of Cardiology, 74(10), 1290-1300. https://doi.org/10.1016/j.jacc.2019.06.065

Lobo, AS, Cantu, SM, Sharkey, SW, Grey, EZ, Storey, K, Witt, D, Benson, G, Garberich, RF, Kubota, Y, Bairey Merz, CN & Henry, TD 2019, 'Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction', Journal of the American College of Cardiology, vol. 74, no. 10, pp. 1290-1300. https://doi.org/10.1016/j.jacc.2019.06.065

@article{5b1a1c3e187d4e238127da9449c62d6c,

title = "Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction",

abstract = "Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction (MI) in younger women, often treated conservatively due to revascularization risks. Revascularization outcomes are largely unknown in SCAD presenting with ST-segment elevation myocardial infarction (STEMI). Objectives: The purpose of this study was to compare revascularization strategies and outcomes of STEMI-SCAD with STEMI atherosclerosis (STEMI-ATH). Methods: Consecutive STEMI patients were retrospectively analyzed (2003 to 2017) at 2 regional STEMI programs (Minneapolis Heart Institute and Cedars-Sinai Smidt Heart Institute) with 3-year outcomes. Results: Among 5,208 STEMI patients, SCAD was present in 53 (1\%; 93\% female). SCAD prevalence was 19\% in female STEMI patients age ≤50 years. Compared with STEMI-ATH, STEMI-SCAD patients were younger (age 49 ± 10 years vs. 63 ± 13 years), were more often female (93\% vs. 27\%), and had more frequent cardiogenic shock (19\% vs. 9\%); all p ≤ 0.03. In STEMI-SCAD, the culprit artery was more commonly left main (13\% vs. 1\%) or left anterior descending (47\% vs. 38\%); both p = 0.003. Acute revascularization was lower in STEMI-SCAD (70\% vs. 97\%); p < 0.001. In STEMI-SCAD, acute revascularization included percutaneous coronary intervention (PCI), n = 33 (62\%), or bypass grafting, n = 4 (8\%); PCI success was 91\%. Those with revascularization were more likely to have shock, left main culprit, proximal dissection, and initial TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to 1. The 3-year survival was 98\% for STEMI-SCAD versus 84\% for STEMI-ATH; p < 0.001. Conclusions: STEMI-SCAD represents an important STEMI subset, particularly among younger women, characterized by significantly greater frequency of left main or left anterior descending culprit and cardiogenic shock than STEMI-ATH. Primary PCI is successful in most STEMI-SCAD patients, with low 3-year mortality.",

keywords = "SCAD, STEMI, cardiogenic shock, left main dissection, women",

author = "Lobo, \{Angie S.\} and Cantu, \{Stephanie M.\} and Sharkey, \{Scott W.\} and Grey, \{Elizabeth Z.\} and Katelyn Storey and Dawn Witt and Gretchen Benson and Garberich, \{Ross F.\} and Yasuhiko Kubota and \{Bairey Merz\}, \{C. Noel\} and Henry, \{Timothy D.\}",

note = "Publisher Copyright: {\textcopyright} 2019 American College of Cardiology Foundation",

year = "2019",

month = sep,

day = "10",

doi = "10.1016/j.jacc.2019.06.065",

language = "English (US)",

volume = "74",

pages = "1290--1300",

journal = "Journal of the American College of Cardiology",

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TY - JOUR

T1 - Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction

AU - Lobo, Angie S.

AU - Cantu, Stephanie M.

AU - Sharkey, Scott W.

AU - Grey, Elizabeth Z.

AU - Storey, Katelyn

AU - Witt, Dawn

AU - Benson, Gretchen

AU - Garberich, Ross F.

AU - Kubota, Yasuhiko

AU - Bairey Merz, C. Noel

AU - Henry, Timothy D.

PY - 2019/9/10

Y1 - 2019/9/10

N2 - Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction (MI) in younger women, often treated conservatively due to revascularization risks. Revascularization outcomes are largely unknown in SCAD presenting with ST-segment elevation myocardial infarction (STEMI). Objectives: The purpose of this study was to compare revascularization strategies and outcomes of STEMI-SCAD with STEMI atherosclerosis (STEMI-ATH). Methods: Consecutive STEMI patients were retrospectively analyzed (2003 to 2017) at 2 regional STEMI programs (Minneapolis Heart Institute and Cedars-Sinai Smidt Heart Institute) with 3-year outcomes. Results: Among 5,208 STEMI patients, SCAD was present in 53 (1%; 93% female). SCAD prevalence was 19% in female STEMI patients age ≤50 years. Compared with STEMI-ATH, STEMI-SCAD patients were younger (age 49 ± 10 years vs. 63 ± 13 years), were more often female (93% vs. 27%), and had more frequent cardiogenic shock (19% vs. 9%); all p ≤ 0.03. In STEMI-SCAD, the culprit artery was more commonly left main (13% vs. 1%) or left anterior descending (47% vs. 38%); both p = 0.003. Acute revascularization was lower in STEMI-SCAD (70% vs. 97%); p < 0.001. In STEMI-SCAD, acute revascularization included percutaneous coronary intervention (PCI), n = 33 (62%), or bypass grafting, n = 4 (8%); PCI success was 91%. Those with revascularization were more likely to have shock, left main culprit, proximal dissection, and initial TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to 1. The 3-year survival was 98% for STEMI-SCAD versus 84% for STEMI-ATH; p < 0.001. Conclusions: STEMI-SCAD represents an important STEMI subset, particularly among younger women, characterized by significantly greater frequency of left main or left anterior descending culprit and cardiogenic shock than STEMI-ATH. Primary PCI is successful in most STEMI-SCAD patients, with low 3-year mortality.

AB - Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction (MI) in younger women, often treated conservatively due to revascularization risks. Revascularization outcomes are largely unknown in SCAD presenting with ST-segment elevation myocardial infarction (STEMI). Objectives: The purpose of this study was to compare revascularization strategies and outcomes of STEMI-SCAD with STEMI atherosclerosis (STEMI-ATH). Methods: Consecutive STEMI patients were retrospectively analyzed (2003 to 2017) at 2 regional STEMI programs (Minneapolis Heart Institute and Cedars-Sinai Smidt Heart Institute) with 3-year outcomes. Results: Among 5,208 STEMI patients, SCAD was present in 53 (1%; 93% female). SCAD prevalence was 19% in female STEMI patients age ≤50 years. Compared with STEMI-ATH, STEMI-SCAD patients were younger (age 49 ± 10 years vs. 63 ± 13 years), were more often female (93% vs. 27%), and had more frequent cardiogenic shock (19% vs. 9%); all p ≤ 0.03. In STEMI-SCAD, the culprit artery was more commonly left main (13% vs. 1%) or left anterior descending (47% vs. 38%); both p = 0.003. Acute revascularization was lower in STEMI-SCAD (70% vs. 97%); p < 0.001. In STEMI-SCAD, acute revascularization included percutaneous coronary intervention (PCI), n = 33 (62%), or bypass grafting, n = 4 (8%); PCI success was 91%. Those with revascularization were more likely to have shock, left main culprit, proximal dissection, and initial TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to 1. The 3-year survival was 98% for STEMI-SCAD versus 84% for STEMI-ATH; p < 0.001. Conclusions: STEMI-SCAD represents an important STEMI subset, particularly among younger women, characterized by significantly greater frequency of left main or left anterior descending culprit and cardiogenic shock than STEMI-ATH. Primary PCI is successful in most STEMI-SCAD patients, with low 3-year mortality.

KW - SCAD

KW - STEMI

KW - cardiogenic shock

KW - left main dissection

KW - women

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DO - 10.1016/j.jacc.2019.06.065

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Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction

Abstract

Bibliographical note

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Keywords

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