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Prevalence and disease spectrum of extracoronary arterial abnormalities in spontaneous coronary artery dissection

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dc.contributor.author Persu, Alexandre
dc.contributor.author Garcia Guimaraes, Marcos
dc.contributor.author Adlam, David
dc.date.accessioned 2022-09-06T07:16:38Z
dc.date.available 2022-09-06T07:16:38Z
dc.date.issued 2022
dc.identifier.citation Persu A, Lopez-Sublet M, Al-Hussaini A, Pappaccogli M, Radhouani I, Van der Niepen P, et al. Prevalence and disease spectrum of extracoronary arterial abnormalities in spontaneous coronary artery dissection. JAMA Cardiol. 2022 Feb 1; 7(2): 159-66. DOI: 10.1001/jamacardio.2021.4690
dc.identifier.issn 2380-6591
dc.identifier.uri http://hdl.handle.net/10230/53994
dc.description.abstract Importance: Spontaneous coronary artery dissection (SCAD) has been associated with fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities. However, the prevalence, severity, and clinical relevance of these abnormalities remain unclear. Objective: To assess the prevalence and spectrum of FMD and other extracoronary arterial abnormalities in patients with SCAD vs controls. Design, setting, and participants: This case series included 173 patients with angiographically confirmed SCAD enrolled between January 1, 2015, and December 31, 2019. Imaging of extracoronary arterial beds was performed by magnetic resonance angiography (MRA). Forty-one healthy individuals were recruited to serve as controls for blinded interpretation of MRA findings. Patients were recruited from the UK national SCAD registry, which enrolls throughout the UK by referral from the primary care physician or patient self-referral through an online portal. Participants attended the national SCAD referral center for assessment and MRA. Exposures: both patients with SCAD and healthy controls underwent head-to-pelvis MRA (median time between SCAD event and MRA, 1 [IQR, 1-3] year). Main outcome and measures: the diagnosis of FMD, arterial dissections, and aneurysms was established according to the International FMD Consensus. Arterial tortuosity was assessed both qualitatively (presence or absence of an S curve) and quantitatively (number of curves ≥45%; tortuosity index). Results: of the 173 patients with SCAD, 167 were women (96.5%); mean (SD) age at diagnosis was 44.5 (7.9) years. The prevalence of FMD was 31.8% (55 patients); 16 patients (29.1% of patients with FMD) had involvement of multiple vascular beds. Thirteen patients (7.5%) had extracoronary aneurysms and 3 patients (1.7%) had dissections. The prevalence and degree of arterial tortuosity were similar in patients and controls. In 43 patients imaged with both computed tomographic angiography and MRA, the identification of clinically significant remote arteriopathies was similar. Over a median 5-year follow-up, there were 2 noncardiovascular-associated deaths and 35 recurrent myocardial infarctions, but there were no primary extracoronary vascular events. Conclusions and relevance: in this case series with blinded analysis of patients with SCAD, severe multivessel FMD, aneurysms, and dissections were infrequent. The findings of this study suggest that, although brain-to-pelvis imaging allows detection of remote arteriopathies that may require follow-up, extracoronary vascular events appear to be rare.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher American Medical Association
dc.rights © American Medical Association. All Rights Reserved. http://dx.doi.org/10.1001/jamacardio.2021.4690
dc.subject.other Cor -- Malalties
dc.subject.other Aneurismes
dc.subject.other Sistema cardiovascular--Malalties
dc.title Prevalence and disease spectrum of extracoronary arterial abnormalities in spontaneous coronary artery dissection
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1001/jamacardio.2021.4690
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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