PCI recommended in high-risk SCAD cases

Although a conservative approach to revascularization in spontaneous coronary artery dissection (SCAD) is preferred, percutaneous coronary intervention (PCI) may be required in high-risk cases, according to new research published in Heart.

“This study demonstrates that although more extensive stenting may be required, with an elevated risk of procedural complications, improved coronary flow and good medium-term outcomes can be achieved with PCI,” wrote first author Deevia Kotecha, MBBS, of the University of Leicester in the U.K., and colleagues. “More extensive dissection, proximal segment location and an absence of contrast penetration of the false lumen associate with the highest risk of PCI complications.”

With the goal of investigating outcomes in a large observational SCAD-PCI cohort derived from three national registries, Kotecha et al. studied the balance of risks and benefits of PCI in a SCAD population.

The cohort included 215 SCAD patients, median age 48 years, 94% female, who underwent PCI and 221 SCAD patients who were treated with a more conservative approach. 

“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,” the authors wrote.

Among the patients undergoing PCI, 38.6% experienced complications related to the procedure. The most common complications were hematoma extension (27.0%) and iatrogenic dissection (8.4%). Also, 13% of patients experienced complications that were serious. 

In spite of the risks, SCAD-PCI led to improved TIMI flow in 84.3% of patients and worse TIMI flow in just 7%. 

"Interestingly, these gains were mostly seen in cases where stenting rather than more limited wiring or plain old balloon angioplasty strategies was adopted," the authors added. 

Data on post-PCI major adverse cardiovascular and cerebrovascular events and left ventricular function outcomes also gave researchers reasons to consider PCI a success when treating high-risk SCAD patients. 

Read the full study here

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