Interventional Versus Conservative Strategy in Patients With Spontaneous Coronary Artery Dissections: Insights From DISCO Registry
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Published:2023-06
Issue:6
Volume:16
Page:
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ISSN:1941-7640
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Container-title:Circulation: Cardiovascular Interventions
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language:en
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Short-container-title:Circ: Cardiovascular Interventions
Author:
Benenati Stefano1ORCID, Giacobbe Federico2ORCID, Zingarelli Antonio3ORCID, Macaya Fernando4ORCID, Biolè Carloalberto5, Rossi Angelica6, Pavani Marco7, Quadri Giorgio8, Barbero Umberto9, Erriquez Andrea10, Aranzulla Tiziana8, Cavallino Chiara11, Buccheri Dario12, Rolfo Cristina7, Patti Giuseppe13ORCID, Gonzalo Nieves4ORCID, Chinaglia Alessandra5, Musumeci Giuseppe7, Escaned Javier4ORCID, Varbella Ferdinando7, Cerrato Enrico7ORCID, Porto Italo13ORCID, Bianco Matteo, Annibali Gianmarco, Bruno Francesco, D’Ascenzo Fabrizio, Nicolino Annamaria, Bernelli Chiara, Salinas Pablo, Bettari Luca, Bordoni Elisabetta, Infantino Vincenzo, Gambino Alfonso, Rognoni Andrea, Mennuni Marco, Cinconze Sebastian, Boi Alberto, Tomassini Francesco, Franzè Alfonso, Savio Luca Lo, Loi Bruno, Iannaccone Mario, De Benedictis Michele, Campo Gianluca, Ugo Fabrizio, Giachet Alessandra Truffa, Greco Lucchina Giuseppe Pietro, Cassano Francesco, Gagnor Andrea, Beqaraj Federico, Gaido Luca, Perfetti Matteo, Lombardi Primiano
Affiliation:
1. University of Genoa, Italy (S.B., I.P.). 2. Cardiology Department, AOU Citta` della Salute e della Scienza di Torino, Turin, Italy (F.G.). 3. Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy (A.Z., I.P.). 4. Hospital Clínico San Carlos, IdiSSC, Universidad Complutense de Madrid, Spain (F.M., N.G., J.E.). 5. Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy (C.B., A.C.). 6. Division of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy (A.R.). 7. Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Italy (M.P., C.R., G.M., F.V., E.C.). 8. Division of Cardiology, Ordine Ospedale Mauriziano Umberto I, Torino (TO), Italy (G.Q., T.A.). 9. Division of Cardiology Ospedale Maggiore Ss. Annunziata - Savigliano (CN), Italy (U.B.). 10. Division of Cardiology, University of Ferrara, Italy (A.E.). 11. Division of Cardiology, Sant’Andrea Hospital, Vercelli, Italy (C.C.). 12. Interventional Cardiology Unit, Department of Cardiology, S. Antonio Abate Hospital, Trapani, Italy (D.B.). 13. University of Eastern Piedmont, Department of Thoracic and Cardiovascular Diseases, Maggiore della Carità Hospital, Novara, Italy (G.P.).
Abstract
Background:
The optimal management of patients with spontaneous coronary artery dissection remains debated.
Methods:
Patients enrolled in the DISCO (Dissezioni Spontanee Coronariche) Registry up to December 2020 were included. The primary end point was major adverse cardiovascular events, a composite of all-cause death, nonfatal myocardial infarction, and repeat percutaneous coronary intervention (PCI). Independent predictors of PCI and medical management were investigated.
Results:
Among 369 patients, 129 (35%) underwent PCI, whereas 240 (65%) were medically managed. ST-segment–elevation myocardial infarction (68% versus 35%,
P
<0.001), resuscitated cardiac arrest (9% versus 3%,
P
<0.001), proximal coronary segment involvement (32% versus 7%,
P
<0.001), and Thrombolysis in Myocardial Infarction flow 0 to 1 (54% versus 20%,
P
<0.001) were more frequent in the PCI arm. In-hospital event rates were similar. Between patients treated with PCI and medical therapy, there were no differences in terms of major adverse cardiovascular events at 2 years (13.9% versus 11.7%,
P
=0.467), all-cause death (0.7% versus 0.4%,
P
=0.652), myocardial infarction (9.3% versus 8.3%,
P
=0.921) and repeat PCI (12.4% versus 8.7%,
P
=0.229). ST-segment–elevation myocardial infarction at presentation (odds ratio [OR], 3.30 [95% CI, 1.56–7.12];
P
=0.002), proximal coronary segment involvement (OR, 5.43 [95% CI, 1.98–16.45];
P
=0.002), Thrombolysis in Myocardial Infarction flow grade 0 to 1 and 2 (respectively, OR, 3.22 [95% CI, 1.08–9.96];
P
=0.038; and OR, 3.98 [95% CI, 1.38–11.80];
P
=0.009) and luminal narrowing (OR per 5% increase, 1.13 [95% CI, 1.01–1.28];
P
=0.037) were predictors of PCI, whereas the 2B-angiographic subtype predicted medical management (OR, 0.25 [95% CI, 0.07–0.83];
P
=0.026).
Conclusions:
Clinical presentation and procedural variables drive the choice of the initial therapeutic approach in spontaneous coronary artery dissection. If PCI is needed, it seems to be associated with a similar risk of short-to-mid-term adverse events compared to medical treatment.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04415762.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
7 articles.
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