Abstract 17969: Percutaneous Coronary Intervention for Acute Spontaneous Coronary Artery Dissection is Associated with Reduced Rates of Technical Success
Background: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic acute coronary syndrome (ACS). Acute outcomes with percutaneous coronary intervention (PCI) in this patient group remain unclear.
Methods: We performed a single center retrospective study and identified 87 patients with SCAD of whom 39 received percutaneous coronary intervention (PCI) as an index treatment strategy (SCAD-PCI). We compared risk factors and procedural outcomes in the SCAD-PCI group with a control group who underwent PCI for atherosclerotic ACS (n=389). Matching was based on age, gender, date, and type of presentation (ST-elevation MI [STEMI] vs non ST-elevation MI [NSTEMI] vs unstable angina [UA]). PCI was successful if treated lesions had <20% residual stenosis with TIMI 3 flow. If >2 additional stents were placed due to extension of dissection or hematoma, the procedure was defined as complicated.
Results: Mean age of SCAD-PCI was 41.8 + 9.7 and 90% were female. Nineteen (49%) presented with STEMI, 19 (49%) with NSTEMI, and 1 (2%) with UA. Six (15%) had ventricular fibrillation. When compared to matched PCI controls, SCAD-PCI exhibited markedly lower rates of hyperlipidemia, hypertension, diabetes mellitus and tobacco use (each p<0.001). Procedural success was less frequent in SCAD-PCI compared with controls (62% vs 92%, p<0.001). Detailed procedural analysis of SCAD-PCI indicated 12/17 (71%) of those presenting with TIMI 0-1 flow underwent successful uncomplicated procedures vs only 7/22 (32%) of those with baseline TIMI 2-3 flow (p<0.02). Reasons for procedural failure or complication in those with TIMI 2-3 flow were failure to cross with wire or device (5/22), final loss of flow after stenting (5/22) and requirement for ≥ 2 further stents due to extension of dissection or intramural hematoma (5/22).
Conclusions: Patients undergoing PCI for acute SCAD have a low burden of atherosclerotic risk factors, but technical success rates are markedly reduced compared with PCI for atherosclerotic ACS. Only a small percentage of PCI cases were successful and uncomplicated among those with presenting TIMI 2-3 flow. We suggest careful consideration of risks versus benefits when considering PCI for acute SCAD particularly in the setting of normal baseline TIMI flow.
- Acute coronary syndromes
- Percutaneous coronary intervention
- Coronary syndromes
- Sudden cardiac death
- Interventional cardiology
- © 2012 by American Heart Association, Inc.