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Risks and benefits of percutaneous coronary intervention in spontaneous coronary artery dissection

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dc.contributor.author Kotecha, Deevia
dc.contributor.author Garcia Guimaraes, Marcos
dc.contributor.author Adlam, David
dc.date.accessioned 2021-09-17T07:37:38Z
dc.date.available 2021-09-17T07:37:38Z
dc.date.issued 2021
dc.identifier.citation Kotecha D, Garcia-Guimaraes M, Premawardhana D, Pellegrini D, Oliver-Williams C, Bountziouka V et al. Risks and benefits of percutaneous coronary intervention in spontaneous coronary artery dissection. Heart. 2021;107(17):1398-406. DOI: 10.1136/heartjnl-2020-318914
dc.identifier.issn 1355-6037
dc.identifier.uri http://hdl.handle.net/10230/48476
dc.description.abstract Objective: To investigate percutaneous coronary intervention (PCI) practice in an international cohort of patients with spontaneous coronary artery dissection (SCAD). To explore factors associated with complications and study angiographic and longer term outcomes. Methods: SCAD patients (n=215, 94% female) who underwent PCI from three national cohort studies were investigated and compared with a matched cohort of conservatively managed SCAD patients (n=221). Results: SCAD-PCI patients were high risk at presentation with only 8.8% undergoing PCI outside the context of ST-elevation myocardial infarction/cardiac arrest, thrombolysis in myocardial infarction (TIMI) 0/1 flow or proximal dissections. PCI complications occurred in 38.6% (83/215), with 13.0% (28/215) serious complications. PCI-related complications were associated with more extensive dissections (multiple vs single American Heart Association coronary segments, OR 1.9 (95% CI: 1.06-3.39),p=0.030), more proximal dissections (proximal diameter per mm, OR 2.25 (1.38-3.67), p=0.001) and dissections with no contrast penetration of the false lumen (Yip-Saw 2 versus 1, OR 2.89 (1.12-7.43), p=0.028). SCAD-PCI involved long lengths of stent (median 46mm, IQR: 29-61mm). Despite these risks, SCAD-PCI led to angiographic improvements in those with reduced TIMI flow in 84.3% (118/140). Worsening TIMI flow was only seen in 7.0% (15/215) of SCAD-PCI patients. Post-PCI major adverse cardiovascular and cerebrovascular events (MACCE) and left ventricular function outcomes were favourable. Conclusion: While a conservative approach to revascularisation is favoured, SCAD cases with higher risk presentations may require PCI. SCAD-PCI is associated with longer stent lengths and a higher risk of complications but leads to overall improvements in coronary flow and good medium-term outcomes in patients.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher BMJ Publishing Group
dc.relation.ispartof Heart. 2021;107(17):1398-406
dc.rights © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
dc.rights.uri https://creativecommons.org/licenses/by/4.0/
dc.title Risks and benefits of percutaneous coronary intervention in spontaneous coronary artery dissection
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1136/heartjnl-2020-318914
dc.subject.keyword Acute coronary syndrome
dc.subject.keyword Percutaneous coronary intervention
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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