Dissection spontanée des artères coronaires : Série nationale tunisienne
DOI :
https://doi.org/10.62438/tunismed.v104i03.6475Mots-clés :
Dissection spontanée de l'artère coronaire, Syndrome coronarien aigu , Grossesse , PronosticRésumé
Introduction: La dissection spontanée de l'artère coronaire (DSAC) reste insuffisamment caractérisée. Cette étude visait à évaluer l'évolution précoce et à long terme des patients avec DSAC.
Méthodes: Étude nationale menée sur 25 ans (depuis 2000), avec inclusions prospectives (depuis 2017) de patients avec DSAC documentée. Le critère de jugement principal était les événements indésirables cardiaques et cérébrovasculaires majeurs intrahospitaliers et à long terme.
Résultats: 87 patients. Âge moyen 47,5±11 ans, 71% de femmes, 84% ne présentaient aucun ou un seul facteur de risque cardiovasculaire conventionnel. L’association à une grossesse (DSAC-P) représentait 9%. Un infarctus du myocarde avec sus-décalage de ST et un choc cardiogénique ont été décrits respectivement chez 51% et 7% des patients. 101 lésions de DSAC (60% de type 1, 37% de type 2 et 3% de type 3) ont été observées. Une stratégie conservatrice était possible chez 84% des patients dont 15% ont nécessité une revascularisation ultérieure urgente. Une stratégie invasive a été associée à cinq complications majeures, dont une fatale. Six décès hospitaliers ont été rapportés (7%), dont quatre DSAC-P. A16 mois, les taux d’événements majeurs et de mortalité étaient respectivement de 17% et 9%. Deux récidives de DSAC ont été rapportées.
Conclusions: La DSAC a affecté une population d'âge moyen, majoritairement féminine, présentant peu ou pas de facteurs de risque conventionnels. La mortalité hospitalière était élevée, en particulier dans la DSAC-P. Une stratégie invasive était associée à des complications fréquentes ...( résumé tronqué à 250 mots).
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Adlam D, Alfonso F, Maas A, Vrints C, Writing Committee. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J 2018;39:3353–68. https://doi.org/10.1093/ eurheartj/ehy080.
Hayes SN, Tweet MS, Adlam D, Kim ESH, Gulati R, Price JE, et al. Spontaneous Coronary Artery Dissection: JACC State-of- the-Art Review. J Am Coll Cardiol 2020;76:961–84. https://doi. org/10.1016/j.jacc.2020.05.084.
Combaret N, Motreff P. Registre national des dissections coronaires spontanées : le registre DISCO. Ann Cardiol Angéiologie 2023;72:101684. https://doi.org/10.1016/j.ancard.2023.101684.
Saw J, Starovoytov A, Aymong E, Inohara T, Alfadhel M, McAlister C, et al. Canadian Spontaneous Coronary Artery Dissection Cohort Study: 3-Year Outcomes. J Am Coll Cardiol 2022;80:1585–97. https://doi.org/10.1016/j.jacc.2022.08.759.
Saw J, Starovoytov A, Humphries K, Sheth T, So D, Minhas K, et al. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. Eur Heart J 2019;40:1188–97. https://doi.org/10.1093/eurheartj/ehz007.
Daoulah A, Al-Faifi SM, Alhamid S, Youssef AA, Alshehri M, Al- Murayeh M, et al. Spontaneous Coronary Artery Dissection in the Gulf: G-SCAD Registry. Angiology 2021;72:32–43. https://doi. org/10.1177/0003319720946974.
Feldbaum E, Thompson EW, Cook TS, Sanghavi M, Wilensky RL,Fiorilli PN, et al. Management of spontaneous coronary artery dissection: Trends over time. Vasc Med Lond Engl 2023;28:131–8. https://doi.org/10.1177/1358863X231155305.
Garcia-Guimarães M, Fernández-Rodríguez D. Spontaneous coronary artery dissection: A look back to build momentum. Int J Cardiol 2024;397:131557. https://doi.org/10.1016/j. ijcard.2023.131557.
Lettieri C, Zavalloni D, Rossini R, Morici N, Ettori F, Leonzi O, et al. Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection. Am J Cardiol 2015;116:66–73. https://doi. org/10.1016/j.amjcard.2015.03.039.
Nakashima T, Noguchi T, Haruta S, Yamamoto Y, Oshima S, Nakao K, et al. Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan. Int J Cardiol 2016;207:341–8. https://doi. org/10.1016/j.ijcard.2016.01.188.
McGrath-Cadell L, McKenzie P, Emmanuel S, Muller DWM, Graham RM, Holloway CJ. Outcomes of patients with spontaneous coronary artery dissection. Open Heart 2016;3:e000491. https://doi. org/10.1136/openhrt-2016-000491.
Roura G, Ariza-Solé A, Rodriguez-Caballero IF, Gomez-Lara J, Ferreiro JL, Romaguera R, et al. Noninvasive Follow-Up of Patients With Spontaneous Coronary Artery Dissection With CT Angiography. JACC Cardiovasc Imaging 2016;9:896–7. https://doi.org/10.1016/j. jcmg.2015.06.011.
Rashid HNZ, Wong DTL, Wijesekera H, Gutman SJ, Shanmugam VB, Gulati R, et al. Incidence and characterisation of spontaneous coronary artery dissection as a cause of acute coronary syndrome--A single-centre Australian experience. Int J Cardiol 2016;202:336–8. https://doi.org/10.1016/j.ijcard.2015.09.072.
Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, et al. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation 2012;126:579–88. https:// doi.org/10.1161/CIRCULATIONAHA.112.105718.
Saw J. Coronary angiogram classification of spontaneous coronary artery dissection. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv 2014;84:1115–22. https://doi.org/10.1002/ccd.25293.
Eleid MF, Guddeti RR, Tweet MS, Lerman A, Singh M, Best PJ, et al. Coronary Artery Tortuosity in Spontaneous Coronary Artery Dissection. Circ Cardiovasc Interv 2014;7:656–62. https://doi. org/10.1161/CIRCINTERVENTIONS.114.001676.
Chi G, Najafi H, Montazerin SM, Lee JJ. Factors associated with recurrent spontaneous coronary artery dissection: a systematic review and meta-analysis. Coron Artery Dis 2022;33:566–73. https://doi.org/10.1097/MCA.0000000000001168.
Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document| Circulation n.d. https://www.ahajournals.org/doi/10.1161/ CIRCULATIONAHA.117.029289 (accessed May 31, 2025).
Hc P. Dissecting aneurysm of coronary artery in a woman aged 42.Br Med J 1931;1:667.
Zeven K. Pregnancy-Associated Spontaneous Coronary Artery Dissection in Women: A Literature Review. Curr
Ther Res 2023;98:100697. https://doi.org/10.1016/j. curtheres.2023.100697.
Alameh A, Jabri A, Aleyadeh W, Nasser F, Al Abdouh A, Kondapaneni M, et al. Pregnancy-Associated Myocardial Infarction: A Review of Current Practices and Guidelines. Curr Cardiol Rep 2021;23:142. https://doi.org/10.1007/s11886-021-01579-z.
Spontaneous Coronary Artery Dissection Associated With Pregnancy - ScienceDirect n.d. https://www.sciencedirect.com/science/article/pii/S0735109717375988?via%3Dihub (accessed January 4, 2024).
Pregnancy and Spontaneous Coronary Artery Dissection: Lessons From Survivors and Nonsurvivors | Circulation n.d. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.122.059635(accessed March 25, 2024).
Pregnancy and the Risk of Spontaneous Coronary Artery Dissection| Circulation: Cardiovascular Interventions n.d. https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.117.004941(accessed April 4, 2024).
Faden MS, Bottega N, Benjamin A, Brown RN. A nationwide evaluation of spontaneous coronary artery dissection in pregnancy and the puerperium. Heart Br Card Soc 2016;102:1974–9. https://doi.org/10.1136/heartjnl-2016-309403.
Havakuk O, Goland S, Mehra A, Elkayam U. Pregnancy and the Risk of Spontaneous Coronary Artery Dissection. Circ
Cardiovasc Interv 2017;10:e004941. https://doi.org/10.1161/CIRCINTERVENTIONS.117.004941.
Ito H, Taylor L, Bowman M, Fry ETA, Hermiller JB, Van Tassel JW. Presentation and therapy of spontaneous coronary artery dissection and comparisons of postpartum versus nonpostpartum cases. Am J Cardiol 2011;107:1590–6. https://doi.org/10.1016/j.amjcard.2011.01.043.
Mortensen KH, Thuesen L, Kristensen IB, Christiansen EH. Spontaneous coronary artery dissection: a Western Denmark Heart Registry study. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv 2009;74:710–7. https://doi.org/10.1002/ccd.22115.
Vanzetto G, Berger-Coz E, Barone-Rochette G, Chavanon O, Bouvaist H, Hacini R, et al. Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients. Eur J Cardiothorac Surg 2009;35:250–4. https://doi.org/10.1016/j.ejcts.2008.10.023.
Alfonso F, Paulo M, Lennie V, Dutary J, Bernardo E, Jiménez-Quevedo P, et al. Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a “conservative” therapeutic strategy. JACC Cardiovasc Interv 2012;5:1062–70. https://doi.org/10.1016/j.jcin.2012.06.014.
Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv 2014;7:645–55. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001760.
Rogowski S, Maeder MT, Weilenmann D, Haager PK, Ammann P, Rohner F, et al. Spontaneous Coronary Artery Dissection: Angiographic Follow-Up and Long-Term Clinical Outcome in a Predominantly Medically Treated Population. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv 2017;89:59–68. https://doi. org/10.1002/ccd.26383.
Motreff P, Malcles G, Combaret N, Barber-Chamoux N, Bouajila S, Pereira B, et al. How and when to suspect spontaneous coronary artery dissection: novel insights from a single-centre series on prevalence and angiographic appearance. EuroIntervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol 2017;12:e2236–43. https://doi.org/10.4244/EIJ-D-16-00187.
Bouajila S. Dissection coronaire spontanée : données épidémiologiques, cliniques et angiographiques issues du registre
national français DISCO 2018:71.
Würdinger M, Schweiger V, Gilhofer T, Cammann VL, Badorff A,Koleva I, et al. Twenty-five-year trends in incidence, angiographic appearance, and management of spontaneous coronary artery dissection. Int J Cardiol 2024;395:131429. https://doi. org/10.1016/j.ijcard.2023.131429.
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