Author + information
- Jamil Cade1,
- Bárbara Freitas Fiorin2,
- Carolina Pereira2,
- Claudia Alves3,
- David Adlam4,
- Marcelo Franken2,
- Pedro A. Lemos5 and
- Adriano Caixeta2
- 1Hospital Santa Marcelina, Hospital Albert Einstein, São Paulo, São Paulo, Brazil
- 2Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- 3Paulista School of Medicine, São Paulo, São Paulo, Brazil
- 4University of Leicester, Leicester, United Kingdom
- 5Heart Institute-InCor, University of São Paulo, São Paulo, São Paulo, Brazil
SCAD is an uncommon and under-diagnosed disease and may be a potentially fatal disorder. The few data in medical literature have been based in case reports and small case-series. Besides there is no consensus of the best approach in acute phase treatment and long-term follow-up will be necessary to increase the knowledge and survival of these patients.
From 2000 to 2017 we analyzed 120 SCAD patients in 40 tertiary hospitals divided in two groups based in acute phase treatment: Clinical (conservative treatment) or Interventional (percutaneuous coronary intervention - PCI or coronary artery bypass graft - CABG). Demographic data, clinical and angiographic presentation were shown in the total patients and each group, as well as the occurrence of major adverse cardiac events (MACCE) in the long-term follow-up. Statistical analysis and Kaplan-Meier were calculated.
Of 120 SCAD patients, 78 were in clinical and 42 were in interventional groups. Clinical-demographic and angiographic results was summarized in Table and the event-free survival in the long-term follow-up was summarized in Kaplan-Meier curves (below).
SCAD is an important cause of acute coronary syndrome in young female patients without classic coronary risk factors. The majority presentation is myocardial infarction and the interventional treatment is more frequent in STEMI patients with cardiogenic shock and right coronary artery dissections. The occurrence of MACCE and recurrence of SCAD is not infrequent regardless of treatment in acute phase and the long-term follow-up shows that this entity cannot be neglected.
CORONARY: Acute Coronary Syndromes