Conditions and Factors Associated With Spontaneous Coronary Artery Dissection (from a National Population-Based Cohort Study)

https://doi.org/10.1016/j.amjcard.2018.10.012Get rights and content

The pathophysiology of spontaneous coronary artery dissection (SCAD) is heterogeneous, associated with systemic arteriopathies and inflammatory diseases, and often compounded by environmental precipitants, genetics, or stressors. However, the frequency of these associated conditions with SCAD on a population level remains unknown. Therefore, the objective of this analysis was to evaluate heterogeneous phenotypes of SCAD in the United States using data from the Nationwide Inpatient Sample collected from January 1, 2004, to September 31, 2015. Among 66,360 patients diagnosed with SCAD, the mean age was 63.1 ± 13.2 years and 44.2% were women. A total of 3,415 (5.14%) had depression, 670 (1.0%) had rheumatoid arthritis, 640 (0.96%) had anxiety, 545 (0.82%) had a migraine disorder, 440 (0.66%) used steroids, 385 (0.58%) had malignant hypertension, 280 (0.42%) had systemic lupus erythematosus, 250 (0.38%) had cocaine abuse, 215 (0.32%) had hypertensive heart or renal disease, 130 (0.19%) had coronary spasm, 105 (0.16%) had fibromuscular dysplasia, 85 (0.13%) had Crohn's disease, 75 (0.11%) had celiac disease, 60 (0.09%) had adult autosomal dominant polycystic kidney disease, 60 (0.09%) had hormone replacement therapy, 55 (0.08%) had sarcoidosis, 55 (0.08%) had amphetamine abuse, 15 (0.02%) had granulomatosis polyangiitis, 10 (0.02%) had α1-antitrypsin deficiency, 10 (0.02%) had Marfan syndrome, 10 (0.02%) had Ehlers-Danlos syndrome, 10 (0.02%) had Kawasaki disease, 10 (0.02%) had polyarteritis nodosa, and 5 (0.01%) had multiparity. In conclusion, most cases of SCAD had no apparent concomitant arteriopathy, inflammatory disorder, or evident risk factor.

Section snippets

Methods

We performed the analysis using the NIS database, a component of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. The NIS aggregates yearly data from over 8 million hospital stays involving over 1,000 hospitals and provides nationwide information on hospital utilization, charges, and quality of care (http://www.hcup-us.ahrq.gov/db/nation/nis/nisrelatedreports.jsp). Data were extracted from the NIS using ICD-9 codes from January 1, 2004, to

Results

A total of 66,360 of patients were diagnosed with SCAD. The mean age was 63.1 ± 13.2 years and 44.2% were women. SCAD and its associated conditions are presented in Figure 1. SCAD was associated with <1% each of coronary spasm, cocaine abuse, amphetamine abuse, migraine disorder, rheumatoid arthritis, Ehlers-Danlos syndrome, Marfan syndrome, α1-antitrypsin deficiency, adult polycystic kidney disease, polyarteritis nodosa, Kawasaki disease, celiac disease, granulomatosis polyangiitis, steroid

Discussion

To the best of our knowledge, this is the first study about conditions related to SCAD using a national database. There were 2 main findings. First, consistent with previously published case reports, we demonstrated that SCAD was associated with a variety of heterogeneous conditions, many of which are not associated with traditional ACS.4, 5,10, 12 Second, our study highlighted the use of a large database potentially to characterize an uncommon disease such as SCAD.

Although SCAD is mainly

Disclosures

Dr. Deepak L. Bhatt discloses the following relations—Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott),

Acknowledgment

None.

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