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Medical presentation of sufferers with spontaneous coronary artery dissection.
Catheter Cardiovasc Interv. 2017 Jun 01;89(7):1149-1154
Authors: Luong C, Starovoytov A, Heydari M, Sedlak T, Aymong E, Noticed J
Summary
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an rare however essential reason behind myocardial infarction (MI) particularly in youthful ladies. Nonetheless, the medical presentation and the acuity of signs prompting invasive administration in SCAD sufferers haven’t been described. Understanding these presenting options could enhance SCAD analysis and administration.
METHODS: We reviewed SCAD sufferers who have been prospectively adopted on the Vancouver Common Hospital SCAD Clinic. Their presenting signs and unstable options have been obtained from detailed medical histories and hospital admission documentation. Baseline traits, predisposing and precipitating situations, angiographic findings, administration methods, in-hospital, and long-term occasions have been recorded prospectively.
RESULTS: We included 196 SCAD sufferers who had full documentation of their presenting signs. The bulk have been ladies (178/196; 90.eight%) and all introduced with MI (24.zero% STEMI). Probably the most frequent presenting symptom was chest discomfort, reported by 96%. Different signs included arm ache (49.5%), neck ache (22.1%), nausea or vomiting (23.four%), diaphoresis (20.9%), dyspnea (19.three%), and again ache (12.2%). Ventricular tachycardia/fibrillation occurred in eight.1% (16/196), with 1.zero% having cardiac arrest. The time from symptom onset to hospital presentation was 1.1?±?three.zero days. NSTEMI sufferers had longer delay for coronary angiography in contrast with STEMI (2.zero?±?2.5 days vs. zero.eight?±?1.7 days, P?=?zero.002). Total, 34.2% had unstable signs upon arrival for coronary angiography. These with unstable signs have been extra prone to endure repeat angiography (65.7% vs. 50.four%, P?=?zero.zero49), and repeat or unplanned revascularization (14.9% vs. 5.four%, P?=?zero.033) throughout acute hospitalization.
CONCLUSION: Chest discomfort was probably the most frequent presenting symptom with SCAD and one-third had unstable signs prompting pressing invasive angiography. © 2017 Wiley Periodicals, Inc.
PMID: 28244197 [PubMed – indexed for MEDLINE]