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Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Left Main Coronary Artery Stenosis: A Systematic Review and Meta-analysis Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure Successful bailout stenting strategy against lethal coronary dissection involving left main bifurcation Management of left main disease: an update Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main and Multivessel Coronary Artery Disease: Do We Have the Evidence? P2Y12 Inhibitor Monotherapy with Clopidogrel Versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Two-year outcomes following unprotected left main stenting with first vs new-generation drug-eluting stents: the FINE registry. EuroIntervention. Discrepancies in Measurement of the Thoracic Aorta: JACC Review Topic of the Week Role of intravascular ultrasound in patients with acute myocardial infarction undergoing percutaneous coronary intervention Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis

Original Research2019 Mar 9. [Epub ahead of print]

JOURNAL:Am J Cardiol. Article Link

Prevalence of Coronary Vasospasm Using Coronary Reactivity Testing in Patients With Spontaneous Coronary Artery Dissection

Solaru KW, Heupler F, Kim ESH et al. Keywords: spontaneous coronary artery dissection; prevalence; MI, sudden cardiac death; coronary vasospasm

ABSTRACT


Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction and sudden cardiac death, particularly in young to middle-aged women. Coronary vasospasm is another condition believed to be associated with SCAD; however, this has only been shown in isolated case reports to date. We sought to examine the association of SCAD and coronary vasospasm by reporting the experience of coronary vasospasm testing in patients with a history of previous SCAD in a large, tertiary referral center. We conducted a single-center retrospective review of patients with history of SCAD confirmed by angiography who received provocative testing using ergonovine in the Cleveland Clinic cardiac catheterization lab from January 1990 to December 2016. Positive vasospasm was defined as: (1) total or subtotal occlusion of at least 1 major coronary artery induced by administration of ergonovine and (2) resolution of said occlusion with the administration of nitrates. Patients with history of strong trauma to the chest and iatrogenic dissection (e.g., catheter-induced) were excluded from the study. We identified 11 patients who satisfied all inclusion criteria. All participants were women and the mean age was 47 years: 73% received screening for fibromuscular dysplasia and of those, 38% were found to have the diagnosis. Only 1 of 11 patients had a positive vasospasm test in the setting of ergonovine administration in the catheterization lab. In conclusion, we found a low prevalence of coronary vasospasm in individuals with confirmed previous SCAD.