Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health System
BackgroundCoronary revascularization in patients with spontaneous coronary artery dissection (SCAD) is challenging. Indications and results of percutaneous coronary interventions (PCI) in SCAD patients are not well established.AimTo assess indications and results of PCI in SCAD.MethodsThe minimum ba...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1054413/full |
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| author | Fernando Alfonso Cristina Fernández-Pérez Cristina Fernández-Pérez Náyade del Prado Marcos García-Guimaraes José Luis Bernal José Luis Bernal Teresa Bastante David del Val María García-Márquez Javier Elola |
| author_facet | Fernando Alfonso Cristina Fernández-Pérez Cristina Fernández-Pérez Náyade del Prado Marcos García-Guimaraes José Luis Bernal José Luis Bernal Teresa Bastante David del Val María García-Márquez Javier Elola |
| author_sort | Fernando Alfonso |
| collection | DOAJ |
| description | BackgroundCoronary revascularization in patients with spontaneous coronary artery dissection (SCAD) is challenging. Indications and results of percutaneous coronary interventions (PCI) in SCAD patients are not well established.AimTo assess indications and results of PCI in SCAD.MethodsThe minimum basic data set of the Spanish National Health System (years 2016−2019) was used to identify 804 episodes of acute myocardial infarction (AMI) and SCAD, with a crude in-hospital mortality rate of 3%. Of these, 368 (46.8%) patients were revascularized with PCI during admission whereas 436 (54.2%) were managed conservatively.ResultsRevascularization and in-hospital mortality rates both declined over the study period (p for trend both < 0.05). SCAD patients treated with PCI were older, more frequently male, and had higher frequency of diabetes, ST-segment elevation AMI and cardiogenic shock, compared to patients managed conservatively. The crude in-hospital mortality rate was higher in patients treated with PCI (4.9% vs. 1.4%; p = 0.004). However, after adjusting by propensity score (223 pairs) the in-hospital mortality rate was similar in the two groups (Adj OR: 1.21; 95%CI: 0.30−1.57; p = 0.76). Readmissions at 30-days were higher in patients managed conservatively (7.1 vs. 1.6%, p < 0.001) and this difference was maintained after propensity score adjustment (Adj average treatment effect: 2% vs. 12.2%; OR: 0.15; 95%CI: 0.04−0.45; p < 0.001).ConclusionRevascularization is frequently used in unselected patients with AMI and SCAD but its use is declining. Patients with SCAD treated with PCI have a higher in-hospital mortality but this appears to be explained by their adverse baseline clinical characteristics. |
| first_indexed | 2024-04-11T07:48:46Z |
| format | Article |
| id | doaj.art-d2e07d1303a14ce99ff1e89818fc3f4b |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T07:48:46Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-d2e07d1303a14ce99ff1e89818fc3f4b2022-12-22T04:36:10ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-12-01910.3389/fcvm.2022.10544131054413Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health SystemFernando Alfonso0Cristina Fernández-Pérez1Cristina Fernández-Pérez2Náyade del Prado3Marcos García-Guimaraes4José Luis Bernal5José Luis Bernal6Teresa Bastante7David del Val8María García-Márquez9Javier Elola10Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, SpainDepartment of Preventive Medicine, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, SpainFundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, SpainFundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, SpainDepartment of Cardiology, Hospital del Mar – Parc de Salut Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, SpainFundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, SpainDepartment of Information and Management Control, Hospital Universitario 12 de Octubre, Madrid, SpainDepartment of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, SpainDepartment of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, SpainFundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, SpainFundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, SpainBackgroundCoronary revascularization in patients with spontaneous coronary artery dissection (SCAD) is challenging. Indications and results of percutaneous coronary interventions (PCI) in SCAD patients are not well established.AimTo assess indications and results of PCI in SCAD.MethodsThe minimum basic data set of the Spanish National Health System (years 2016−2019) was used to identify 804 episodes of acute myocardial infarction (AMI) and SCAD, with a crude in-hospital mortality rate of 3%. Of these, 368 (46.8%) patients were revascularized with PCI during admission whereas 436 (54.2%) were managed conservatively.ResultsRevascularization and in-hospital mortality rates both declined over the study period (p for trend both < 0.05). SCAD patients treated with PCI were older, more frequently male, and had higher frequency of diabetes, ST-segment elevation AMI and cardiogenic shock, compared to patients managed conservatively. The crude in-hospital mortality rate was higher in patients treated with PCI (4.9% vs. 1.4%; p = 0.004). However, after adjusting by propensity score (223 pairs) the in-hospital mortality rate was similar in the two groups (Adj OR: 1.21; 95%CI: 0.30−1.57; p = 0.76). Readmissions at 30-days were higher in patients managed conservatively (7.1 vs. 1.6%, p < 0.001) and this difference was maintained after propensity score adjustment (Adj average treatment effect: 2% vs. 12.2%; OR: 0.15; 95%CI: 0.04−0.45; p < 0.001).ConclusionRevascularization is frequently used in unselected patients with AMI and SCAD but its use is declining. Patients with SCAD treated with PCI have a higher in-hospital mortality but this appears to be explained by their adverse baseline clinical characteristics.https://www.frontiersin.org/articles/10.3389/fcvm.2022.1054413/fullacute myocardial infarctionacute coronary syndromeangiographycoronary revascularizationcomplicationsmortality |
| spellingShingle | Fernando Alfonso Cristina Fernández-Pérez Cristina Fernández-Pérez Náyade del Prado Marcos García-Guimaraes José Luis Bernal José Luis Bernal Teresa Bastante David del Val María García-Márquez Javier Elola Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health System Frontiers in Cardiovascular Medicine acute myocardial infarction acute coronary syndrome angiography coronary revascularization complications mortality |
| title | Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health System |
| title_full | Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health System |
| title_fullStr | Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health System |
| title_full_unstemmed | Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health System |
| title_short | Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health System |
| title_sort | characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection a study from the administrative minimum data set of the spanish national health system |
| topic | acute myocardial infarction acute coronary syndrome angiography coronary revascularization complications mortality |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1054413/full |
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