Coronary Artery Tortuosity in Spontaneous Coronary Artery Dissection

  • Mackram F. Eleid
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
  • Raviteja R. Guddeti
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
  • Marysia S. Tweet
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
  • Amir Lerman
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
  • Mandeep Singh
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
  • Patricia J. Best
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
  • Terri J. Vrtiska
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
  • Megha Prasad
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
  • Charanjit S. Rihal
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
  • Sharonne N. Hayes
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
  • Rajiv Gulati
    From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.

書誌事項

タイトル別名
  • Angiographic Characteristics and Clinical Implications

抄録

<jats:sec> <jats:title>Background—</jats:title> <jats:p>Spontaneous coronary artery dissection (SCAD) is an increasingly recognized nonatherosclerotic cause of acute coronary syndrome. The angiographic characteristics of SCAD are largely undetermined. The goal of this study was to determine the prevalence of coronary tortuosity in SCAD and whether it may be implicated in the disease.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> Patients with confirmed SCAD (n=246; 45.3±8.9 years; 96% women) and 313 control patients without SCAD or coronary artery disease who underwent coronary angiography were included in this case–control study. Angiograms were reviewed for coronary tortuosity and assigned a tortuosity score. Tortuosity was common in patients presenting with their first SCAD event (78% versus 17% in controls; <jats:italic>P</jats:italic> <0.0001; tortuosity score, 4.41±1.73 versus 2.33±1.49 in controls; <jats:italic>P</jats:italic> <0.0001) despite a low prevalence of hypertension (34%). Recurrent SCAD (n=40) occurred within segments of tortuosity in 80% of cases. Severe tortuosity (≥2 consecutive curvatures ≥180°) was associated with a higher risk of recurrent SCAD (hazard ratio, 3.29; 95% confidence interval, 0.99–8.29; <jats:italic>P</jats:italic> =0.05). Tortuosity score >5 was associated with a trend toward higher risk of recurrent SCAD ( <jats:italic>P</jats:italic> =0.16). Prespecified angiographic markers of tortuosity including corkscrew appearance and multivessel symmetrical tortuosity were associated with extracoronary vasculopathy including fibromuscular dysplasia ( <jats:italic>P</jats:italic> <0.05 for both). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Coronary artery tortuosity is highly prevalent in the SCAD population and is associated with recurrent SCAD. Recurrent SCAD most often occurs within segments of tortuosity. Angiographic features of SCAD are associated with extracoronary vasculopathy, including fibromuscular dysplasia. These findings suggest that coronary tortuosity may serve as a marker or potential mechanism for SCAD.</jats:p> </jats:sec>

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