Research Shows Reperfusion with Primary Percutaneous Coronary Intervention is Successful in Most STEMI-SCAD Patients
Largest known study compared strategies and outcomes for STEMI-SCAD with STEMI-ATH
MINNEAPOLIS / September 10, 2019: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute myocardial infarction, often afflicting younger women without coronary atherosclerosis. It is often treated conservatively due to revascularization risks, yet revascularization outcomes have been largely unknown in SCAD presenting with ST-segment elevation myocardial infarction (STEMI). New research from the Minneapolis Heart Institute Foundation® (MHIF) and Cedars-Sinai Smidt Heart Institute published in the September issue of the Journal of the American College of Cardiology found that reperfusion with primary percutaneous coronary intervention (PCI) is successful in most STEMI-SCAD patients, with low three-year mortality.
The purpose of the study, the largest known of this type according to the researchers, was to compare revascularization strategies and outcomes of STEMI-SCAD with STEMI atherosclerosis (STEMI-ATH). While most STEMI events are related to STEMI-ATH, the findings showed that STEMI-SCAD represents an important STEMI subset, particularly among younger women. Study results documented SCAD prevalence of 1 percent among all STEMI patients and 19 percent among STEMI women under 50 years of age.
“These research findings have significant implications for improving treatment and saving lives for patients who present with SCAD and experience ST-segment elevation myocardial infarctions, which is a particularly dangerous type of heart attack often resulting in major heart muscle damage,” said Dr. Scott Sharkey, a Minneapolis Heart Institute® cardiologist and a principal investigator on the study. “Most of these patients are females who are young, healthy and active at the time; in fact, SCAD is afflicting a growing number of women in their 40s and 50s. SCAD is different from a typical heart attack and is caused by a spontaneous tear in a coronary artery that is apparently previously healthy without evidence of cholesterol buildup (atherosclerosis).”
Study Protocol and Results
From 2003 to 2017, the researchers queried the comprehensive databases of two established regional STEMI programs (Minneapolis Heart Institute®, Minneapolis, Minn.; and Cedars-Sinai Smidt Heart Institute, Los Angeles, Calif.) to identify more than 5,200 consecutive STEMI patients within 24 hours of symptom onset who presented for emergency primary PCI treatment. Clinical and angiographic characteristics, revascularization strategies and outcomes were compared for consecutive patients with STEMI-SCAD and STEMI-ATH.
Compared with STEMI-ATH, STEMI-SCAD patients were younger and more often female. In STEMI-SCAD, the culprit artery was more commonly left main or left anterior descending, and patients were more likely to experience cardiogenic shock than STEMI-ATH patients.
Acute revascularization was lower in STEMI-SCAD (70 percent vs. 97 percent). In STEMI-SCAD, acute revascularization included percutaneous coronary intervention (PCI, 62 percent) or bypass grafting (8 percent), and PCI success was 91 percent. The three-year survival was 98 percent for STEMI-SCAD versus 84 percent for STEMI-ATH.
“Like SCAD, heart conditions that afflict women are often different from those that affect men, and most of these conditions have not been adequately studied,” said Dr. Sharkey. “In fact, women’s heart health research is 35 years behind that of men. Through critical research such as this SCAD treatment research at the Minneapolis Heart Institute Foundation and the establishment of its new Women’s Cardiovascular Disease Science Center, we are working to advance the understanding of heart disease in women, how to prevent it, and how to optimize patient care.”
About the Minneapolis Heart Institute Foundation®
The Minneapolis Heart Institute Foundation (MHIF) strives to create a world without heart and vascular disease. To achieve this bold vision, it is dedicated to improving the cardiovascular health of individuals and communities through innovative research and education.
- Scientific Innovation and Research — MHIF is a recognized research leader in the broadest range of cardiovascular medicine and population health initiatives. Each year MHIF leads more than 175 active research projects and publishes more than 175 peer-reviewed abstracts. Cardiologists, hospitals and communities around the world adopt MHIF protocols to save lives, improve care and create healthier living opportunities.
- Education and Outreach — MHIF provides more than 10,000 hours of education each year putting its research into practice to improve outcomes. And, MHIF leads cutting-edge, transformative population health research to connect, engage, inform and empower individuals and communities to improve their health.
The Minneapolis Heart Institute Foundation’s work is funded by generous donors and sponsors and supports research initiatives of Minneapolis Heart Institute® at Abbott Northwestern Hospital. Minneapolis Heart Institute® physicians provide care for patients at Abbott Northwestern Hospital in Minneapolis and at 38 community sites across Minnesota and western Wisconsin. More information can be found at https://mplsheart.org