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Characteristics and outcomes of patients with spontaneous coronary artery dissection who suffered sudden cardiac arrest

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Spontaneous coronary artery dissection (SCAD) can cause life-threatening ventricular arrhythmias, but the characteristics and outcomes of this population are not well characterized. We sought to determine the characteristics and outcomes of patients with SCAD who suffered sudden cardiac arrest, whether treated with or without an implantable cardioverter-defibrillator (ICD).

Methods

Retrospective cohort study of patients diagnosed with SCAD between 2006 and 2016.

Results

Eleven of 208 SCAD patients suffered sudden cardiac arrest (5.3%). Those who suffered cardiac arrest were more likely to have pregnancy-associated SCAD (27.3% vs 7.1%, p = 0.018). They were more likely to have left main (18.2% vs 1.0%, p = 0.01) or proximal coronary vessel involvement (36.4% vs 8.1%, p = 0.002), and with left ventricular ejection fraction of < 50% (45.5% vs 13.2%, p = 0.013). Percutaneous coronary intervention was more commonly performed in patients who suffered cardiac arrest (54.6% vs 8.6%, p < 0.001). Left main or proximal LAD involvement increased the odds of cardiac arrest by over 6-fold (OR 6.2, 95% CI 1.2–32.9, p = 0.03). Eight of the 11 patients suffered VT/VF arrest, of which one was treated with an ICD and one with a wearable cardioverter-defibrillator. Of these, no shocks were reported at follow-up and no ventricular arrhythmic events were reported in those not receiving defibrillator treatment.

Conclusion

Sudden cardiac arrest in SCAD patients is associated with left main or proximal coronary lesions. Secondary prevention ICD did not show benefit in this cohort. Future larger studies are needed to determine the role of ICD therapy in SCAD patients who suffer cardiac arrest.

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Authors and Affiliations

  1. Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, 1526 North Edgemont Street, 2nd Floor, Los Angeles, CA, 90027, USA

    Derek Phan, Ryan Clare, Cy Kim, Naing Moore & Ming-Sum Lee

  2. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    Lewei Duan

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  1. Derek Phan
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  2. Ryan Clare
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  3. Lewei Duan
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Correspondence to Ming-Sum Lee.

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Phan, D., Clare, R., Duan, L. et al. Characteristics and outcomes of patients with spontaneous coronary artery dissection who suffered sudden cardiac arrest. J Interv Card Electrophysiol 60, 77–83 (2021). https://doi.org/10.1007/s10840-019-00695-9

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  • DOI: https://doi.org/10.1007/s10840-019-00695-9

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