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Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Rare causes of acute coronary syndromes include coronary artery embolism or dissection, and coronary spasm. Embolism may be due to aortic, mitral valve stenosis, infective endocarditis, atrial fibrillation, or marantic endocarditis. Coronary artery dissection may occur in atherosclerotic or nonatherosclerotic coronary arteries. The nonatherosclerotic form is most common in women that are pregnant or have given birth as well as patients with connective tissue disorders such as fibromuscular dysplasia. Diabetic patients with acute coronary syndromes have increased mortality rates compared to nondiabetic patients. Diabetes mellitus is linked to a proinflammatory and prothrombotic state that can lead to plaque rupture. Risk factors for acute coronary syndromes, aside from diabetes, include increased age, hypertension, high cholesterol, smoking, insufficient physical activity, unhealthy diet, being overweight or obese, family history (of angina, heart disease, or stroke), personal history (of hypertension, preeclampsia, or gestational diabetes), and the COVID-19 infection.
Acute Coronary Syndromes in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Pavan Reddy, Gassan Moady, Uri Elkayam
Coronary angiography in pregnancy is associated with increased risk of catheter-induced coronary artery dissection, especially in the left main artery; this iatrogenic risk together with the documented high rates of spontaneous healing of the dissected arteries leads to the suggestion of conservative management in stable low-risk patients [9,29]. Nonselective contrast injection in the aortic root, avoidance of deep catheter intubation (especially with the radial approach), and minimal use of low-pressure injections are recommended to decrease the risk of dissection. A suggested algorithm for the treatment of PASCAD is given in Figure 14.1. Fetal radiation exposure remains a significant concern during cardiac catheterization of pregnant women, as the average amount of radiation exposure to the fetus is estimated at 3 mSv. External abdominal shielding, lower magnification, low fluoroscopy frame rates, and using the radial approach are acceptable methods to reduce risk of radiation exposure [26].
The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
In adults, isolated coronary artery dissection may precipitate acute infarction and sudden death. The process is distinct from aortic dissection and starts as a subadventitial haematoma, which compresses the vessel lumen. This haematoma may rupture into the lumen and create a dissection track. The pathogenesis is not clear but it is linked to pregnancy in many cases. There is an adventitial inflammatory process with eosinophils and basophils, which are reactive to the intramural haematoma (Figure 7.28). In individuals who survive, the angiogram can return to close to normal as the haematoma is organized and becomes smaller. There is also a link to Marfan's syndrome or other connective tissue gene defects in some cases, as well as cocaine use.
Contemporary trends in the incidence of spontaneous coronary artery dissection (SCAD) – ethnic and household income disparities
Published in Expert Review of Cardiovascular Therapy, 2022
Mohsin S Mughal, Hafsa Akbar, Ikwinder P Kaur, Ali R Ghani, Hasan Mirza, Weiyi Xia, Mohammed Haris Usman, Mahboob Alam, Tarek Helmy
Spontaneous coronary artery dissection (SCAD) is an under-recognized condition that occurs due to the non-iatrogenic tear of the coronary arterial wall. SCAD can impede the blood flow to myocardium and present as acute coronary syndrome, arrhythmias, or sudden death. The underlying pathophysiology is unclear; however, fibromuscular dysplasia (FMD), extracoronary vasculopathy, systemic arteriopathies, pregnancy, and physical and emotional stresses have been characterized as potential associations, while their causality is yet to be proven. In the last decade, as more evidence is accumulating, SCAD is increasingly recognized, which may contribute to 35% of acute coronary syndrome (ACS) among women ≤50 years of age [1]. Data regarding the incidence of SCAD is growing. Utilizing the NIS in a nationwide sample from 2010 to 2017, we aimed to investigate the overall incidence, as well as the trends of SCAD incidence based on race (White, African American, Hispanic, and others), household income, and the U.S. census regions: CENS-R1 (Census Region 1: Northeast), CENS-R2 (Census Region 2: Midwest), CENS-R3 (Census Region 3: South), and CENS-R4 (Census Region 4: West).
Spontaneous coronary artery dissection in young female acute coronary syndrome patients: a single-centre retrospective cohort study
Published in Acta Cardiologica, 2021
Frederic De Roeck, Benjamin Scott, Carl Convens, Paul Vermeersch
Spontaneous coronary artery dissection is an uncommon, non-atherosclerotic cause of acute coronary syndrome. It is defined as an atraumatic, non-iatrogenic separation of coronary wall layers following intramural haemorrhage and is predominantly diagnosed in young to middle-aged women without classic cardiovascular risk factors [2,3]. Due to an often atypical presentation in this low-risk population and the absence of atherosclerotic hallmarks on coronary angiogram, SCAD diagnosis remains challenging and a striking underdiagnosis of SCAD has recently been highlighted [4]. Nevertheless, early diagnosis remains paramount as optimal treatment strategy differs greatly from atherosclerotic ACS [5]. Over the past decade, SCAD is rapidly gaining attention as a clinical entity in ACS. This increased recognition of SCAD seems multifactorial: a higher index of suspicion, the use of high-sensitive biomarkers and a lower threshold for coronary angiography [6].
Characteristics and hospital outcomes of coronary atherectomy within the United States: a multivariate and propensity-score matched analysis
Published in Expert Review of Cardiovascular Therapy, 2021
Fahed Darmoch, Waqas Ullah, Yasser Al-khadra, Yasar Sattar, Homam Moussa Pacha, Mohamed Zghouzi, Mohamad Soud, Rodrigo Bagur, Srihari S. Naidu, Andrew M. Goldsweig, Mamas Mamas, Emmanouil S Brilakis, M Chadi Alraies
This is a retrospective study using the National Inpatient Sample (NIS) database from 2011 to 2014. The NIS is a publicly available identified database of hospital discharges in the United States, containing data from approximately 8 million hospital stays in each year that was selected using an intricate probability sampling design and the weighting scheme recommended by the Agency for Healthcare Research and Quality, which is intended to represent all discharges from non-federal hospitals [10]. We included all patients who were ≥18 and underwent PCI. We identified 2,035,039 patients who had undergone PCI as a primary procedure using the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) codes (00.66, 36.06, and 36.07), out of which 5095 patients underwent atherectomy using the codes (17.55) (supplemental Table 1S summarizes ICD-9 codes used for other comorbidities). The primary outcome was in-hospital mortality. Secondary outcomes were in-hospital complications which included 1) coronary artery dissection; 2) coronary artery aneurysm; 3) vascular complications (injury to blood vessels, accidental puncture, injury to retroperitoneum, vascular complications requiring surgery); 4) major bleeding; 5) acute kidney injury (AKI); and 6) post-procedure stroke.