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Benenati, Stefano;
Giacobbe, Federico;
Zingarelli, Antonio;
Macaya, Fernando;
Biolè, Carloalberto;
Rossi, Angelica;
Pavani, Marco;
Quadri, Giorgio;
Barbero, Umberto;
Erriquez, Andrea;
Aranzulla, Tiziana;
Cavallino, Chiara;
Buccheri, Dario;
Rolfo, Cristina;
Patti, Giuseppe;
Gonzalo, Nieves;
Chinaglia, Alessandra;
Musumeci, Giuseppe;
Escaned, Javier;
Varbella, Ferdinando;
Cerrato, Enrico;
Porto, Italo;
Bianco, Matteo;
Annibali, Gianmarco;
[...]
Interventional Versus Conservative Strategy in Patients With Spontaneous Coronary Artery Dissections: Insights From DISCO Registry
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- Media type: E-Article
- Title: Interventional Versus Conservative Strategy in Patients With Spontaneous Coronary Artery Dissections: Insights From DISCO Registry
- Contributor: Benenati, Stefano; Giacobbe, Federico; Zingarelli, Antonio; Macaya, Fernando; Biolè, Carloalberto; Rossi, Angelica; Pavani, Marco; Quadri, Giorgio; Barbero, Umberto; Erriquez, Andrea; Aranzulla, Tiziana; Cavallino, Chiara; Buccheri, Dario; Rolfo, Cristina; Patti, Giuseppe; Gonzalo, Nieves; Chinaglia, Alessandra; Musumeci, Giuseppe; Escaned, Javier; Varbella, Ferdinando; Cerrato, Enrico; Porto, Italo; Bianco, Matteo; Annibali, Gianmarco; [...]
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Published:
Ovid Technologies (Wolters Kluwer Health), 2023
- Published in: Circulation: Cardiovascular Interventions, 16 (2023) 6
- Language: English
- DOI: 10.1161/circinterventions.122.012780
- ISSN: 1941-7640; 1941-7632
- Origination:
- Footnote:
- Description: 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.
- Access State: Open Access