Author + information
- Received April 30, 2019
- Revision received June 3, 2019
- Accepted June 13, 2019
- Published online September 2, 2019.
- Angie S. Lobo, MDa,
- Stephanie M. Cantu, MDb,
- Scott W. Sharkey, MDc,∗ (, )@MHIF_Heart,
- Elizabeth Z. Grey, MDc,
- Katelyn Storey, BAc,
- Dawn Witt, PhDc,
- Gretchen Benson, BAc,
- Ross F. Garberich, MSc,
- Yasuhiko Kubota, MDc,
- C. Noel Bairey Merz, MDd and
- Timothy D. Henry, MDb,c@HenrytTimothy
- aMedical Education Department, Abbott Northwestern Hospital, Minneapolis, Minnesota
- bDivision of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
- cMinneapolis Heart Institute and Foundation, Minneapolis, Minnesota
- dBarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Scott W Sharkey, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 620, Minneapolis, Minnesota 55407.
Background Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction (MI) in younger women, often treated conservatively due to revascularization risks. Revascularization outcomes are largely unknown in SCAD presenting with ST-segment elevation myocardial infarction (STEMI).
Objectives The purpose of this study was to compare revascularization strategies and outcomes of STEMI-SCAD with STEMI atherosclerosis (STEMI-ATH).
Methods Consecutive STEMI patients were retrospectively analyzed (2003 to 2017) at 2 regional STEMI programs (Minneapolis Heart Institute and Cedars-Sinai Smidt Heart Institute) with 3-year outcomes.
Results Among 5,208 STEMI patients, SCAD was present in 53 (1%; 93% female). SCAD prevalence was 19% in female STEMI patients age ≤50 years. Compared with STEMI-ATH, STEMI-SCAD patients were younger (age 49 ± 10 years vs. 63 ± 13 years), were more often female (93% vs. 27%), and had more frequent cardiogenic shock (19% vs. 9%); all p ≤ 0.03. In STEMI-SCAD, the culprit artery was more commonly left main (13% vs. 1%) or left anterior descending (47% vs. 38%); both p = 0.003. Acute revascularization was lower in STEMI-SCAD (70% vs. 97%); p < 0.001. In STEMI-SCAD, acute revascularization included percutaneous coronary intervention (PCI), n = 33 (62%), or bypass grafting, n = 4 (8%); PCI success was 91%. Those with revascularization were more likely to have shock, left main culprit, proximal dissection, and initial TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to 1. The 3-year survival was 98% for STEMI-SCAD versus 84% for STEMI-ATH; p < 0.001.
Conclusions STEMI-SCAD represents an important STEMI subset, particularly among younger women, characterized by significantly greater frequency of left main or left anterior descending culprit and cardiogenic shock than STEMI-ATH. Primary PCI is successful in most STEMI-SCAD patients, with low 3-year mortality.
Funding for this study was provided by the Minneapolis Heart Institute Foundation. Dr. Bairey Merz has received personal honoraria from and served as a consultant to ACRWH (NIH Advisory Council), NIH-CASE (grant review study section), Springer International (book honorarium), Decision Support in Medicine LLC (book honorarium), and NHLBI Research Triangle Institute (RTI) International; and has received personal research grants for WISE HFpEF (sponsor: Cedars-Sinai Medical Center, NCT02582021), RWISE (sponsor: Cedars-Sinai Medical Center, NCT01342029), FAMRI (sponsor: University of California, San Francisco, NCT01639235), WARRIOR Trial (sponsor: University of Florida, NCT03417388), and California Institute for Precision Medicine (sponsor: Cedars-Sinai Medical Center, NCT03064360). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received April 30, 2019.
- Revision received June 3, 2019.
- Accepted June 13, 2019.
- 2019 American College of Cardiology Foundation
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