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Primary PCI in Patients With Spontaneous Coronary Artery Dissection
Quick Takes
- Findings from this retrospective analysis from the Spanish National Health System evaluated the role of primary PCI (PPCI) among patients presenting with STEMI secondary to SCAD.
- Mortality and 30-day hospital readmission rates were similar among SCAD and non-SCAD STEMI patients undergoing PPCI.
- Further investigation is needed to identify clinical and anatomic criteria for SCAD patients who may benefit from PPCI.
Study Questions:
What are the in-hospital mortality and 30-day readmission rates among patients with spontaneous coronary artery dissection (SCAD) related ST-segment elevation myocardial infraction (STEMI) treated with primary percutaneous coronary intervention (PPCI) and non-SCAD STEMI patients undergoing PPCI?
Methods:
Data were obtained from the Spanish National Health System from 2016–2020. Risk-standardized in-hospital mortality ratios (RSMR) and readmission ratios were calculated, and results were adjusted using propensity score (PS) analyses in the two groups.
Results:
A total of 65,957 episodes of PPCI were identified after exclusions. The crude in-hospital mortality rate was 4.8%. Of these, 315 (0.5%) were SCAD PPCI and 65,642 were non-SCAD PPCI. SCAD PPCI patients were younger and more frequently female than non-SCAD PPCI patients. Crude mortality (5.7% vs. 4.8%), RSMR (5.3% vs. 5.3%), and PS adjusted (315 pairs) mortality (5.7% vs. 5.7%) were similar in SCAD PPCI and non-SCAD PPCI patients, respectively. In addition, crude (3% vs. 3.3%) and PS-adjusted (297 pairs) 30-day readmission rates (3% vs. 4%) were also similar in both groups.
Conclusions:
PPCI, when indicated in SCAD patients with STEMI, has similar in-hospital mortality and 30-day readmission rates compared with PPCI for atherothrombotic STEMI. These findings support the value of PPCI in selected patients with SCAD.
Perspective:
Due to concerns about the risk of PCI among SCAD patients, current recommendations favor conservative management in the absence of persistent, clinically relevant ischemia. Findings from this retrospective analysis from the Spanish National Health System evaluated the role of PPCI among patients presenting with STEMI secondary to SCAD. Mortality and 30-day hospital readmission rates were similar among the SCAD and non-SCAD STEMI population undergoing PPCI. While these findings are limited by study design and do not support change in current practice of a default conservative approach, they do provide reassurance about PPCI among select patients with STEMI secondary to SCAD. Further investigation is needed to identify clinical and anatomic criteria for the SCAD patient who may benefit from PPCI.
Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Stable Ischemic Heart Disease, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging, Chronic Angina
Keywords: Acute Coronary Syndrome, Coronary Angiography, Coronary Artery Disease, Dissection, Myocardial Infarction, Patient Readmission, Percutaneous Coronary Intervention, Non-ST Elevated Myocardial Infarction, ST Elevation Myocardial Infarction, Thrombosis
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