Table 3.
Acute Revascularization Outcomes in SCAD
| Reference | Year | Patients, n | Initial Medical Therapy, n (%) | Crossover to Revascularization, n (%) | PCI/CABG as Initial Therapy, n (%) | All In-Hospital Revascularizations, n (%) | All PCI Attempts, n. (% success)* | All CABG Procedures, n (% success) | In-Hospital MI, n (%) | In-Hospital Urgent Revascularizations, n (%) | In-Hospital Mortality, n (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Unal et al169 | 2008 | 6 | 0 | NA | 1/5 (100) | 6 (100) | 1 (0) | 6 (83.3) | NR | 1 (16.7) | 1 (16.7)† |
| Vanzetto et al31 | 2009 | 23 | 10 (43.4) | 0 | 11/2 (56.5) | 13 (56.5) | 11 (72.7) | 5 (100) | 0 | 3 CABG (13) | 1 (4.3)‡ |
| Mortensen et al30 | 2009 | 22 | 7 (31.8) | NR | 13/2 (68.2) | NR | 13 (92.3) | 2 (NR) | NR | NR | 0 |
| Motreff et al170 | 2010 | 12 | 5 (41.7) | 3 (60) | 7/0 (58.3) | 10 (83.3) | 10 (NR) | NR | NR | NR | 1 (8.3)§ |
| Ito et al85 | 2011 | 23 | 18 (78.3) | 4 (22) | 3/3 (26.1) | 9 (39.1) | 5 (60) | 6 (NR) | 2 (8.7) | 4 (17.4) | 0 |
| Alfonso et al9 | 2012 | 45|| | 36 (80) | 7 (19.4) | 8/1 (20) | 16 (35.6) | 16 (81.3) | 2 (50)¶ | 1 (2.22)¶ | 7 (15.6) | 1 (2.22)¶ |
| Saw et al13 | 2014 | 168 | 139 (82.7) | 6 (4.3) | 28/1 (17.3) | 35 (20.8) | 33 (36.4) | 5 (100) | 8 (4.8) | 8 (4.8) | 0 |
| Tweet et al19 | 2014 | 189 | 94 (49.7) | 8 (8.5) | 89/6 (50.3) | 103 (54.4) | 97 (47.4) | 20 (94.1)# | NR | 26 (14) | 1 (0.53)** |
| Lettieri et al10 | 2015 | 134 | 78 (58.2) | 2 (2.6) | 51/5 (41.8) | 58 (43.3) | 55 (72.5) | 8 (87.5) | 7 (5.2) | 7 (5.2) | 3 (2.2)†† |
| Roura et al155 | 2016 | 34 | 26 (76.5) | 0 | 8/0 (23.5) | 8 (23.5) | 8 (75.0) | 0 | 0 | 0 | 0 |
| Rashid et al16 | 2016 | 21 | 17 (80.9) | 0 | 4/0 (17.4) | 4 (17.4) | 4 (100) | 0 | 0 | 0 | 0 |
| Nakashima et al11 | 2016 | 63 | 28 (44.4) | 0 | 34/1 (55.6) | NR | 34 (91.2) | 1 (NR) | NR | NR | NR |
| McGrath-Cadell et al171 | 2016 | 40 | 27 (67.5) | 0 | 12/1 (32.5) | 13 (32.5) | 12 (91.7) | 2 (100) | NR | 1 (2.5) | 0 |
| Cade et al89 | 2017 | 13‡‡ | 7 (53.8) | 2 (28.6) | 4/1 (38.4) | 7 (53.8) | NR | 1 | NR | 2 (15.4) | 1 (7.7) |
| Faden et al87 | 2016 | 79‡‡ | NR | NR | NR | 52 (65.8) | NR | 23 (NR) | NR | NR | 3 |
| Rogowski et al33 | 2017 | 64 | 56 (87.5) | 0 | 7/1 (12.5) | 8 (12.5) | 9 (66.7) | 1 (100) | 0 | 0 | 1 (1.6)§§ |
CABG indicates coronary artery bypass grafting; MI, myocardial infarction; NA, not applicable because all were treated with CABG; NR, not reported or able to be determined from data provided; PCI, percutaneous coronary intervention; and SCAD, spontaneous coronary artery dissection.
Success as defined per author or as patients not requiring second intervention for the same lesion.
Sepsis.
Cardiogenic shock.
Left main SCAD complicated by cardiogenic shock not improved by salvage left main PCI.
Eighteen patients in this cohort had concomitant atherosclerotic heart disease on angiography.
Perioperative MI and death in a patient with severe 3-vessel coronary disease and concomitant atherosclerotic disease.
Two of 34 intended bypass targets unable to be revascularized because of extent of dissection.
Multiorgan failure after bailout CABG for unsuccessful PCI.
One patient died of retrograde aortic dissection after PCI; 1 patient died after emergency CABG for multivessel SCAD with ST-segment–elevation MI and cardiogenic shock; and 1 patient died of out-of-hospital cardiac arrest and cardiogenic shock with coronary anatomy not suitable for revascularization.
All cases pregnancy-associated SCAD.
Left main artery SCAD in late pregnancy, cardiac arrest during emergency cesarean delivery, refractory cardiogenic and hemorrhagic shock.