Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register
Objectives The aim of this study was to conduct a nationwide all comer description of incidence, contemporary management and outcome in Swedish spontaneous coronary artery dissection (SCAD) patients. The incidence of SCAD as well as the management and outcome of these patients is not well described....
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e060949.full |
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| author | Per Tornvall Eva Swahn Dimitrios Venetsanos Troels Yndigegn Sofia Sederholm Lawesson Lena Jonasson Nina Johnston Henrik Wilander Christos Pagonis Christian Dworeck Thomas Kellerth |
| author_facet | Per Tornvall Eva Swahn Dimitrios Venetsanos Troels Yndigegn Sofia Sederholm Lawesson Lena Jonasson Nina Johnston Henrik Wilander Christos Pagonis Christian Dworeck Thomas Kellerth |
| author_sort | Per Tornvall |
| collection | DOAJ |
| description | Objectives The aim of this study was to conduct a nationwide all comer description of incidence, contemporary management and outcome in Swedish spontaneous coronary artery dissection (SCAD) patients. The incidence of SCAD as well as the management and outcome of these patients is not well described.Design A nationwide observational study.Participants and setting All patients with SCAD registered in the Swedish Coronary Angiography and Angioplasty Register from 2015 to 2017 were included. The index angiographies of patients with registered SCAD were re-evaluated at each centre to confirm the diagnosis. Patients with non-SCAD myocardial infarction (MI) (n=32 601) were used for comparison.Outcome measures Outcomes included all-cause mortality, reinfarction or acute coronary reangiography.Results This study found 147 SCAD patients, rendering an incidence of 0.74 per 100 000 per year and a prevalence of 0.43% of all MIs. The average age was 52.9 years, 75.5% were women and 47.6% presented with ST-segment elevation MI. Median follow-up time for major adverse cardiac event was 17.3 months. Percutaneous coronary intervention was attempted in 40.1% of SCAD patients and 30.6% received stent. The use of antithrombotic agents was similar between the groups and there was no difference regarding outcomes, 10.9% vs 13.4%, p=0.75. Mortality was lower in SCAD patients, 2.7% vs 8.0%, p=0.03, whereas SCAD patients more often underwent acute reangiography, 9.5% vs 4.6%, p<0.01.Conclusion In this nationwide, all comer Swedish study, the overall incidence of SCAD was low, including 25% men which is more and in contrast to previous studies. Compared with non-SCAD MI, SCAD patients were younger, with lower cardiovascular risk burden, yet suffered substantial mortality and morbidity and more frequently underwent acute coronary reangiography. |
| format | Article |
| id | doaj-art-5067f38299a841fd957960cbeed12fbb |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-5067f38299a841fd957960cbeed12fbb2025-01-27T17:40:15ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2022-060949Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty registerPer Tornvall0Eva Swahn1Dimitrios Venetsanos2Troels Yndigegn3Sofia Sederholm Lawesson4Lena Jonasson5Nina Johnston6Henrik Wilander7Christos Pagonis8Christian Dworeck9Thomas Kellerth10Cardiology Unit, Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, SwedenDepartment of Health Medicine and Caring Sciences, Linkoping University, Linkoping, SwedenDivision of Cardiology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Karolinska Institutet Solna, Stockholm, Sweden1 Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, SwedenDepartment of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, SwedenDepartment of Health Medicine and Caring Sciences, Linkoping University, Linkoping, SwedenDepartment of Medical Sciences, Cardiology, Uppsala University, Uppsala Clinical Research Center, Uppsala, SwedenDepartment of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, SwedenDepartment of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, SwedenDepartment of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, SwedenDepartment of acute cardiology, Region Värmland, Karlstad, SwedenObjectives The aim of this study was to conduct a nationwide all comer description of incidence, contemporary management and outcome in Swedish spontaneous coronary artery dissection (SCAD) patients. The incidence of SCAD as well as the management and outcome of these patients is not well described.Design A nationwide observational study.Participants and setting All patients with SCAD registered in the Swedish Coronary Angiography and Angioplasty Register from 2015 to 2017 were included. The index angiographies of patients with registered SCAD were re-evaluated at each centre to confirm the diagnosis. Patients with non-SCAD myocardial infarction (MI) (n=32 601) were used for comparison.Outcome measures Outcomes included all-cause mortality, reinfarction or acute coronary reangiography.Results This study found 147 SCAD patients, rendering an incidence of 0.74 per 100 000 per year and a prevalence of 0.43% of all MIs. The average age was 52.9 years, 75.5% were women and 47.6% presented with ST-segment elevation MI. Median follow-up time for major adverse cardiac event was 17.3 months. Percutaneous coronary intervention was attempted in 40.1% of SCAD patients and 30.6% received stent. The use of antithrombotic agents was similar between the groups and there was no difference regarding outcomes, 10.9% vs 13.4%, p=0.75. Mortality was lower in SCAD patients, 2.7% vs 8.0%, p=0.03, whereas SCAD patients more often underwent acute reangiography, 9.5% vs 4.6%, p<0.01.Conclusion In this nationwide, all comer Swedish study, the overall incidence of SCAD was low, including 25% men which is more and in contrast to previous studies. Compared with non-SCAD MI, SCAD patients were younger, with lower cardiovascular risk burden, yet suffered substantial mortality and morbidity and more frequently underwent acute coronary reangiography.https://bmjopen.bmj.com/content/12/6/e060949.full |
| spellingShingle | Per Tornvall Eva Swahn Dimitrios Venetsanos Troels Yndigegn Sofia Sederholm Lawesson Lena Jonasson Nina Johnston Henrik Wilander Christos Pagonis Christian Dworeck Thomas Kellerth Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register BMJ Open |
| title | Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register |
| title_full | Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register |
| title_fullStr | Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register |
| title_full_unstemmed | Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register |
| title_short | Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register |
| title_sort | nationwide observational study of incidence management and outcome of spontaneous coronary artery dissection a report from the swedish coronary angiography and angioplasty register |
| url | https://bmjopen.bmj.com/content/12/6/e060949.full |
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