Spontaneous Coronary Dissection as an Expression of Coronary Artery Disease: Correlation with Vasospasm
Clinical Medicine Research
Volume 4, Issue 1, January 2015, Pages: 21-26
Received: Dec. 25, 2014; Accepted: Jan. 26, 2015; Published: Feb. 10, 2015
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Fumimaro Takatsu, Department of Cardiology, Takatsu NaikaJunkankika, 2-4-7 Mikawaanjo-Hommachi, Anjo, Aichi, Japan
Kenji Takemoto, Department of Cardiology, Anjo Kosei Hospital, 28 Higashihirokute, Anjo, Aichi, Japan
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Background: Artificial coronary artery dissection is observed occasionally during percutaneous coronary intervention. However, “spontaneous” coronary artery dissection (SCAD) is not common and we tried to clarify its characteristics. Methods and Results: We reviewed the serial diagnostic coronary angiograms of 21,500 patients retrospectively. Sixty-two patients showed linear, longitudinal defects that were considered to be the angiographic expression of SCAD, in at least one major coronary artery. Vasospasm was shown in 38 patients. Among the remaining 24 subjects, 18 patients had chest pain even after all coronary narrowings of ≧50 %were treated with coronary intervention or bypass surgery. Chest pain was relieved promptly with sublingual administration of nitrate. Thus, 56 patients (90.3%) with SCAD were demonstrated or considered to have vasospasm. Fifty-two patients of these 56 individuals showed significant (≧50%) narrowing in at least one of the major coronary arteries. In the remaining 4 subjects, 3 patients subsequently developed significant coronary artery disease. Comparison of coronary risk factors was done in the 38 patients shown to have vasospasm and 144 patients with ordinary coronary artery disease. Smoking was more common in the group with vasospasm but there was no difference with regard to the other risk factors. Conclusion: SCAD seems to be an expression of coronary artery disease. However, vasospasm is a common factor in these patients.
Coronary Artery Dissection, Coronary Vasospasm, Smoking
To cite this article
Fumimaro Takatsu, Kenji Takemoto, Spontaneous Coronary Dissection as an Expression of Coronary Artery Disease: Correlation with Vasospasm, Clinical Medicine Research. Vol. 4, No. 1, 2015, pp. 21-26. doi: 10.11648/j.cmr.20150401.15
Roth A, Elkayam U. Acute Myocardial Infarction Associated with Pregnancy. JACC 2008; 52: 171-80.
Mathieu D, Larde D, Vasile N. Primary dissecting aneurysms of the coronary arteries: case report and literature review. Cardiovasc Intervent Radiol 1984; 7:71-4.
Ebersberger U, Levis AJ, Flowers BA, Cho YJ, Winc e WB, Schoepf J. Spontaneous multivessel coronary artery dissection causing massive myocardial infarction. JACC 2013; 61: 589.
Alfonso F, Paulo M, Lennie V, Das-Neves B, Echavarria-Pinto M. Fibromuscular dysplasia and spontaneous coronary artery dissection: coincidental association or causality ? JACC Cardiovasc Interv. 2013; 6: 638-9.
Vrints CJM. Spontaneous coronary artery dissection. Heart 2010; 96:801-8.
Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, Gersh BJ, Khambatta S, Best PJM, Rihal CS, Gulati R. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation 2012; 126: 579-88.
Mark DB, Kong Y, Whalen RE. Variant angina and spontaneous coronary artery dissection. Amer J Cardiol 1985; 56:485-6.
Nishikawa H, Nakanishi S, Nishiyama S, Nishimura S, Seki A, Yamaguchi H. Primary coronary dissection observed at coronary angiography. Amer J Cardiol 1988; 61: 645-8.
Takatsu F. A case of myocardial infarction caused by coronary dissection. Gendai-Igaku 2003; 51: 353-6 (in Japanese).
Yasue H, Horio Y, Nakamura N, Fujii H, Imoto N, Sonoda R, Kugiyama K, Obata K, Morikami Y, Kimura T. Induction of coronary artery vasospasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery vasospasm. Circulation 1986; 74: 955-65.
Sugiishi M, Takatsu F. Cigarette smoking is a major risk factor for coronary vasospasm. Circulation 1993; 87: 76-9.
Takatsu F, Watarai M. Mild stenosis makes prognosis of vasospastic angina worse. Coronary Artery Disease 2011; 22: 1-5.
Alberti KGMM, Zimmet PZ. Definition, diagnosis, and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Provisional Report of a WHO Consultation. Diabet. Med. 1998; 15: 539-53.
Ozaki Y, Keane D, Haase J, Baptista J, Meneveau N, de Feyter PJ, Takatsu F, Serruys PW. Temporal variability and correlation with geometric parameters in vasospastic angina: a quantitative angiographic study. Eur Heart J 1994; 15:61-7.
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