Dissezione Coronarica Spontanea: storia clinica e follow-up a medio-lungo termine in una casistica monocentrica.

Abstract

BACKGROUND:La dissezione coronarica spontanea(SCAD) è una rara patologia non aterosclerotica delle tuniche vascolari coronariche con prevalenza nelle donne di età media e frequente esordio come sindrome coronarica acuta(ACS), talora con arresto cardiaco(ACC) e morte cardiaca improvvisa. OBIETTIVI: Valutazione decorso clinico, outcome ospedaliero e follow-up a medio-lungo termine di coorte di popolazione SCAD. METODI:Analisi retrospettiva monocentrica UOC Cardiologia IRCCS Policlinico San Martino-Genova nell’arco temporale Gen2010-Dic2019: tra 7929 coronarografie consecutive, eseguite per cardiopatia ischemica acuta, cronica o sospetta, sono state identificate 13 SCAD. Raccolti sistematicamente anamnesi, quadro clinico, angiografico, strategia terapeutica e terapia farmacologica in fase ospedaliera; registrati eventi ischemici cardio- e cerebrovascolari ed aritmici in fase acuta ed in follow-up. RISULTATI:Tra 13 SCAD,12(92%) risultavano di sesso femminile, età 47±8 anni, 11(85%) idiopatiche(I-SCAD) e 2(15%) peripartum(P-SCAD).L’esordio clinico è sempre stato come ACS, in prevalenza infarto ST-elevato (STEMI)(92%), in 4(31%) esordito con ACC. In fase ospedaliera, in 11 casi(85%) è stata scelta una strategia inizialmente conservativa, confermandosi alla dimissione in 10(77%),a fronte di una strategia invasiva adottata in soli 3 casi(23%). La sopravvivenza è stata del 100%; registrati 7 eventi avversi cardiovascolari maggiori(54%),di cui 4 recidive STEMI(31%). La terapia prevalente alla dimissione è stata una duplice terapia antiaggregante piastrinica con acido acetilsalicilico e clopidogrel. Nel follow-up(38±26mesi) la sopravvivenza è risultata del 92%(12 casi) senza recidive SCAD ed eventi ischemici correlati all’evento indice. CONCLUSIONI:La nostra coorte SCAD ha presentato un outcome favorevole a breve e medio-lungo termine, si è caratterizzata per l’esteso utilizzo della diagnostica angio-TAC e per la prevalente strategia conservativa durante la fase ospedaliera.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic pathology of the coronary vascular tunics with prevalence in middle-aged women and frequent onset as acute coronary syndrome (ACS), sometimes with cardiac arrest and sudden death. OBJECTIVES: Evaluation of the clinical situation, hospital outcome and medium-long term follow-up of the population cohort SCAD. METHODS: Monocentric retrospective analysis UOC Cardiology IRCCS Policlinico San Martino Genoa in the period from January 2010 to December 2019: among 7929 consecutive coronarographies, performed for acute, chronic or suspected ischemic heart disease, 13 SCAD were identified. Anamnesis, clinical and angiographic situation, therapeutic strategy and drug therapy in the hospital phase were systematically collected; cardio- and cerebrovascular events and arrhythmic ischemic events were recorded in the acute phase and in the follow-up. RESULTS: Among 13 SCAD, 12 (92%) were female, aged 47±8 years, 11 (85%) were idiopathic (I-SCAD) and 2 (15%) were peripartum (P-SCAD). Clinical onset was always ACS, mainly ST-elevated infarction (STEMI) (92%), in 4 (31%) with cardiac arrest. In hospital, an initially conservative strategy was chosen in 11 cases (85%), and confirmed at discharge in 10 (77%), compared to an invasive strategy adopted in only 3 cases (23%). Survival was 100%; There were 7 major adverse cardiovascular events (54%), of which 4 recurrence STEMI (31%). The predominant therapy at discharge was dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. In the follow-up (38±26 months) survival was 92% (12 cases) with no recurrence of SCAD and ischemic events related to the index event. CONCLUSIONS: Our SCAD cohort presented a favorable outcome in the short and medium-long term, it was characterized by the wide use of angio-CT diagnostics and by the prevalent use of the conservative strategy during the hospital phase.