AI Article Synopsis
- Spontaneous coronary artery dissection (SCAD) has become a recognized cause of acute coronary syndrome, and recent studies have looked into how management practices have evolved over time, particularly regarding invasive treatment and imaging techniques.
- A study of 157 SCAD patients treated between 2005 and 2019 revealed that conservative management increased significantly from 35% to 89%, with certain factors like age and pregnancy influencing the decision for revascularization.
- While the use of partial imaging for vascular abnormalities increased, comprehensive vascular imaging remained low and unchanged, but patients who received comprehensive imaging had a higher diagnosis rate of fibromuscular dysplasia (FMD), indicating a need for improved screening practices.
Article Abstract
Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome. Guidance regarding the optimal management of patients with SCAD has been published over the past 10 years, but the impact on clinical practice has not been evaluated. The present study aims to examine if approaches to invasive management, medical therapy, and vascular imaging have changed over time.
Methods: This is a retrospective cohort study of 157 patients treated for SCAD between 2005 and 2019 at an academic health system in Philadelphia, Pennsylvania. We aimed to examine change in management over time, including rates of coronary revascularization, discharge medications, and vascular imaging.
Results: Conservative management of SCAD increased over time from 35% before 2013 to 89% in 2019, < 0.001. Revascularization was associated with younger age, pregnancy-associated SCAD, and lesions of the left main artery, left anterior descending artery, and multiple vessels, < 0.05 for all. Partial imaging for extracoronary vascular abnormalities ranged from 33% before 2013 to 71% in 2018, = 0.146. The rate of comprehensive vascular imaging (cross-sectional head to pelvis imaging) remained low in all time categories (10-18%) and did not change over time. Patients who underwent comprehensive imaging were more likely to be diagnosed with fibromuscular dysplasia (FMD) compared to those with partial imaging (63% vs 15%, < 0.001).
Conclusion: Management of spontaneous coronary artery dissection has changed over time. More patients are being managed conservatively and undergo screening for extracoronary vascular abnormalities such as FMD. Future efforts should focus on improving rates of comprehensive vascular screening.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084514 | PMC |
| http://dx.doi.org/10.1177/1358863X231155305 | DOI Listing |
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