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ABS20191010_0001
| Acute Coronary Syndromes (STEMI, NSTE-ACS) | |
| Stenting of Patients with Spontaneous Coronary Artery Dissection Reduces Morbidity and Mortality in Acute Coronary Syndrome - An Observational Retrospective Study from India | |
| Raghav Sharma1, Arvind Yuvaraj Narasimhan2, Prathap Kumar Pillai3 | |
| RKM Hospital , India1, Sri Narayani Hospital and Research Center, India2, Meditrina Hospital, India3 | |
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Background:
Spontaneous Coronary Artery Dissection (SCAD) is an infrequent cause of acute coronary syndrome & sudden cardiac death. Treatment varies from conservative approach to revascularization. This study was planned to study the profile & benefits of revascularization in ACS patients with underlying SCAD.
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Methods:
Data of all patients admitted in department of cardiology from December 2017 to September 2019 were evaluated. Total 8254 patients during this period underwent coronary angiography. 3434 patients had elective coronary angioplasty. Remaining 2000 patients were reported with ACS. Out of this patient population, patients with angiographic evidence of SCAD were subjected to data analysis. Primary end point of the study was success of PTCA and secondary end points were procedural complications, mortality and MACE scoring.
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Results:
Out of 2000 patients reported with ACS, total of 56 patients had angiographic evidence of underlying SCAD. 27 of these 56 patients were diagnosed with acute STEMI and 29 were diagnosed with unstable angina or NSTEMI. Subgroup analysis showed mean age of 56.64 years with minimum 30 to maximum 80 years. Out of these 56 patients, total 46 patients were reported in the study. Dissections were categorized as Type I, Type II or Type III. Total 13 patients were subjected to Type I and 14 patients were subjected to Type II. Among the STEMI subgroup, total 23 patients had dissection in just single vessel, most of them being the culprit vessel. In the NSTEMI subgroup, 22 patients had SCAD in a single vessel and remaining 7 patients had SCAD in two or more vessels. Majority of males reported in the study were smokers. As per primary objective of the study, successful PTCA was achieved in all patients. There was no procedural complications, in hospital mortality or any MACE in any of the patients.
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Conclusion:
Male smokers had high incidence of SCAD involving multivessel involvement. SCAD may not heal spontaneously at most of the times and patients remain symptomatic with compromised quality of life. Stenting of patients presenting with ACS with underlying SCAD will improve quality of life and reduces morbidity and mortality.
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