Background: Fibromuscular dysplasia (FMD) is widely recognized as an important predisposing condition for spontaneous coronary artery dissection (SCAD). However, it remains unclear in SCAD patients with coexistent extracoronary FMD whether SCAD can be attributed to coronary FMD.
Methods: We retrospectively analyzed consecutive patients enrolled in our Vancouver SCAD registries between September 2009 and October 2019 who were screened for extracoronary FMD. We reviewed coronary angiograms for manifestations of coronary FMD that were previously described (ie, irregular stenosis, smooth stenosis, dilatation/ectasia, and severe tortuosity). Outcome of interest was major adverse cardiovascular event (MACE).
Results: We included 346 SCAD patients, of these, 250 (72.3%) had extracoronary FMD. Patients with FMD were older (54.6 ± 9.5 vs 51.7 ± 9.8 years) and more likely to have prior history of myocardial infarction (7.2% vs 1.0%, P = 0.047) and stroke (4.4% vs 0%, P = 0.081) compared with non-FMD patients. On coronary angiography, severe tortuosity was more prevalent in patients with extracoronary FMD (58.4% vs 36.5%, P < 0.001). Rates of irregular stenosis, smooth stenosis, and dilatation/ectasia were numerically higher in patients with extracoronary FMD, but differences were not significantly different. The rate of MACE at median follow-up of 807 (interquartile range, 392-1096) days was not different between groups (19.6% vs 15.6%; non-FMD as a reference: hazard ratio 1.44; 95% confidence interval, 0.76-2.71, P = 0.261).
Conclusion: SCAD patients with extracoronary FMD were more likely to have coronary FMD manifestations on angiogram, especially severely tortuous vessels, compared with those without extracoronary FMD, with similar clinical outcomes. This may suggest that SCAD can occur at sites of pre-existent subclinical coronary FMD.
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http://dx.doi.org/10.1016/j.cjca.2021.08.019 | DOI Listing |
CJC Open
November 2024
Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes. Fibromuscular dysplasia (FMD) is an idiopathic, nonatherosclerotic, and noninflammatory arterial disease that affects small- to medium-sized arteries that can result in multifocal aneurysms, stenosis, tortuosity, and dissections. Extracoronary FMD has been identified in approximately 70% of SCAD patients and it is recommended that all SCAD patients undergo screening for FMD once in their lifetime using computed tomography angiography from head to pelvis.
View Article and Find Full Text PDFVasc Med
December 2023
Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Am J Hypertens
October 2023
Division of Cardiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Fibromuscular dysplasia (FMD) is an idiopathic and systemic non-inflammatory and non-atherosclerotic arterial disease. Fifteen to 25% of patients with FMD present with arterial dissection in at least one arterial bed. Conversely, a substantial number of patients with renal, carotid, and visceral dissection have underlying FMD.
View Article and Find Full Text PDFVasc Med
April 2023
Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
J Am Coll Cardiol
October 2022
Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Background: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in young to middle-aged women.
Objectives: We aim to define the long-term natural history of SCAD.
Methods: We performed a multicenter, prospective, observational study of patients with nonatherosclerotic SCAD presenting acutely from 22 North American centers.
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