Author + information
- Received June 19, 2017
- Revision received July 30, 2017
- Accepted August 2, 2017
- Published online January 1, 2018.
- Ahmed N. Mahmoud, MDa,∗ (, )
- Siva Sagar Taduru, MDb,
- Amgad Mentias, MDc,
- Dhruv Mahtta, MDd,
- Amr F. Barakat, MDe,
- Marwan Saad, MD, PhDf,
- Akram Y. Elgendy, MDa,
- Mohammad K. Mojadidi, MDa,
- Mohamed Omer, MDb,
- Ahmed Abuzaid, MDg,
- Nayan Agarwal, MDa,
- Islam Y. Elgendy, MDa,
- R. David Anderson, MDa and
- Jacqueline Saw, MDh
- aDivision of Cardiovascular Medicine, University of Florida, Gainesville, Florida
- bDepartment of Medicine, University of Missouri Kansas City, Kansas City, Missouri
- cDivision of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
- dDepartment of Medicine, University of Florida, Gainesville, Florida
- eUPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
- fDepartment of Medicine, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- gDepartment of Cardiovascular Medicine/Heart and Vascular Institute, Sidney Kimmel Medical College at Thomas Jefferson University-Christiana Care Health System, Newark, Delaware
- hDivision of Cardiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
- ↵∗Address for correspondence:
Dr. Ahmed N. Mahmoud, Department of Medicine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road, Gainesville, Florida 32610.
Objectives The authors sought to determine the clinical characteristics and in-hospital survival of women presenting with acute myocardial infarction (AMI) and spontaneous coronary artery dissection (SCAD).
Background The clinical presentation and in-hospital survival of women with AMI and SCAD remains unclear.
Methods The National Inpatient Sample (2009 to 2014) was queried for all women with a primary diagnosis of AMI and concomitant SCAD. Iatrogenic coronary dissection was excluded. The main outcome was in-hospital mortality. Propensity score matching and multivariable logistic regression analyses were performed.
Results Among 752,352 eligible women with AMI, 7,347 had a SCAD diagnosis. Women with SCAD were younger (61.7 vs. 67.1 years of age) with less comorbidity. SCAD was associated with higher incidence of in-hospital mortality (6.8% vs. 3.4%). In SCAD patients, a decrease in in-hospital mortality was evident with time (11.4% in 2009 vs. 5.0% in 2014) and concurred with less percutaneous coronary intervention (PCI) (82.5% vs. 69.1%). Propensity score yielded 7,332 SCAD and 14,352 patients without SCAD. The odds ratio (OR) of in-hospital mortality remained higher with SCAD after propensity matching (OR: 1.87, 95% confidence interval [CI]: 1.65 to 2.11) and on multivariable regression analyses (OR: 2.41, 95% CI: 2.07 to 2.80). PCI was associated with higher mortality in SCAD patients presenting with non–ST-segment elevation myocardial infarction (OR: 2.01; 95% CI: 1.00 to 4.47), but not with STEMI (OR: 0.62; 95% CI: 0.41 to 0.96).
Conclusions Women presenting with AMI and SCAD appear to be at higher risk of in-hospital mortality. Lower rates of PCI were associated with improved survival, with evidence of worse outcomes when PCI was performed for SCAD in the setting of non with ST-segment elevation myocardial infarction.
Dr. Anderson is a consultant for Biosense Webster, a Johnson & Johnson Company. Dr. Saw has received research grants for SCAD research from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, University of British Columbia Division of Cardiology, AstraZeneca, Abbott Vascular, St. Jude Medical, and Servier; has been a consultant for Boston Scientific, Abbott Vascular, and St. Jude Medical; has received honoraria for proctoring from Boston Scientific and St. Jude Medical; and has received speaker honoraria for SCAD from AstraZeneca, St. Jude Medical, and Sunovion. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first two authors contributed equally to this work.
- Received June 19, 2017.
- Revision received July 30, 2017.
- Accepted August 2, 2017.
- 2018 American College of Cardiology Foundation